Sec. 12. (a) As used in this section, "nonparticipating provider" means a provider that has not entered into an agreement with a health maintenance organization to serve as a participating provider.
(b) After September 30, 2009, if a health maintenance organization makes a payment to an enrollee for a health care service rendered by a nonparticipating provider, the health maintenance organization shall include with the payment instrument written notice to the enrollee that includes the following:
(1) A statement specifying the claims covered by the payment instrument.
(2) The name and address of the provider submitting each claim.
(3) The amount paid by the health maintenance organization for each claim.
(4) Any amount of a claim that is the enrollee's responsibility.
(5) A statement in at least 24 point bold type that:
(A) instructs the enrollee to use the payment to pay the nonparticipating provider if the enrollee has not paid the nonparticipating provider in full;
(B) specifies that paying the nonparticipating provider is the enrollee's responsibility; and
(C) states that the failure to make the payment violates the law and may result in collection proceedings or criminal penalties.
As added by P.L.144-2009, SEC.3.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 36. Patient Protection; Clinical Decision Making; Access to Personnel and Facilities
27-13-36-2. Sufficient Number and Type of Primary Care Providers
27-13-36-2.5. Discrimination on Basis of Provider's License or Certification Prohibited
27-13-36-3. Adequate Number of Services and Providers Within Reasonable Proximity of Subscribers
27-13-36-4. Specialty Areas of Primary Care Providers
27-13-36-5. Referrals to Out of Network Providers
27-13-36-6. Continuation of Care Provisions
27-13-36-7. Telephone Access for Authorization of Care
27-13-36-8. Guidelines for Establishing Reasonable Periods for Appointments
27-13-36-9. Coverage and Reimbursement for Expenses for Care Obtained in an Emergency
27-13-36-11. Standards for Continuity of Care
27-13-36-12. Payment to Enrollee for Service Rendered by Nonparticipating Provider; Requirements