New Indiana Law Takes Effect to Address Surprise Billing

A new Indiana law passed last April to address the issue of out-of-network surprise billing took effect January 1, 2018.

House Bill (HB) 1273, “Out-of-Network Covered Health Services,” requires healthcare providers who make referrals to other providers to give notice to patients of possible out-of-network situations. According to the new law, the provider making a referral must provide to the covered individual an electronic or paper copy of written notice that states all the following:

1. That an out of network provider may be called upon to render health care items or services to the covered individual during the course of treatment.
2. That an out of network provider described in subdivision (1) is not bound by the payment provisions that apply to health care items or services rendered by a network provider under the covered individual’s health plan.
3. That the covered individual may contact the covered individual’s health plan before receiving health care items or services rendered by an out of network provider described in subdivision (1):
   1. to obtain a list of network providers that may render the health care items or services; and
   2. for additional assistance.

The bill highlights several exceptions when notification is not required, including the following:

1. A referral for treatment of an emergency medical condition.
2. A referral made:
   1. immediately following treatment of an emergency medical condition; and
   2. by the provider that rendered the treatment of the emergency medical condition.
3. A referral for medically or psychologically necessary therapeutic services rendered to an admitted patient in:
   1. a hospital; or
   2. another facility to which a patient may be admitted for more than twenty-four (24) hours.

The bill also does not affect the following types of referrals:

• to a physician in the same provider group as the referring physician,
• to a physician not specifically named,
• for a patient covered by Medicaid,
• for a patient covered by workers’ compensation insurance, or
• for a patient who is uninsured.

For more information, review a copy of the complete bill HB 1273 at the General Assembly’s website.

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