Sec. 12. (a) If:
(1) the individual who requests a good faith estimate from a practitioner under this chapter is a covered individual with respect to a network plan; and
(2) the practitioner from which the individual requests the good faith estimate is in network with respect to the same network plan;
the good faith estimate that the practitioner provides to the individual under this chapter must be based on the negotiated price to which the practitioner has agreed as an in network provider.
(b) If the individual who requests a good faith estimate from a practitioner under this chapter:
(1) is not a covered individual with respect to any network plan; or
(2) is not a covered individual with respect to a network plan with respect to which the practitioner is in network;
the good faith estimate that the practitioner provides to the individual under this chapter must be based on the price that the practitioner charges for the nonemergency health care service in the absence of any network plan.
As added by P.L.93-2020, SEC.7.
Structure Indiana Code
Title 25. Professions and Occupations
Chapter 9.8. Practitioner Good Faith Estimates
25-1-9.8-1. "Covered Individual"
25-1-9.8-1.5. "Episode of Care"
25-1-9.8-2. "Good Faith Estimate"
25-1-9.8-7. "Nonemergency Health Care Service"
25-1-9.8-10. "Provider Facility"
25-1-9.8-10-b. "Provider Facility"
25-1-9.8-11. Applicability; Request for Good Faith Estimate; Requirements
25-1-9.8-12. In Network Good Faith Estimates; Out of Network Good Faith Estimates
25-1-9.8-13. Provision of Good Faith Estimate
25-1-9.8-15. Provision of Information by Practitioner to Provider Facility
25-1-9.8-16. Practitioner Duty to Give Written Notice of Individual's Right to an Estimate; Rules