Sec. 2. (a) Each health maintenance organization shall develop a system to allow an enrollee to use an appropriate participating provider to manage the enrollee's medical condition when the enrollee's primary care provider determines that the use of another appropriate participating provider is warranted by the enrollee's medical condition.
(b) A primary care provider who makes the required determination under subsection (a) shall refer the enrollee to a participating provider whom the primary care provider determines is appropriate.
(c) A health maintenance organization shall provide coverage under this section for treatment received by an enrollee from an appropriate participating provider when the enrollee is referred to the participating provider as provided in this section for as long as the treatment is appropriate for the medical condition, subject to the terms and conditions of the enrollee's contract with the health maintenance organization.
(d) A contract between a health maintenance organization and a primary care provider may not provide for a financial or other penalty to the primary care provider for making a referral allowed under this section.
As added by P.L.69-1998, SEC.15.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 37. Patient Protection; Choice of Health Care Professional
27-13-37-1. Enrollees Allowed to Choose Primary Care Provider From List
27-13-37-2. Use of Participating Provider Other Than Primary Care Provider
27-13-37-3. Continuity of Care and Referrals When Specialty Care Warranted