58-50-295. Prohibited contract provisions related to reimbursement rates.
No contract with a health care provider shall do any of the following:
(1) Prohibit, or grant a health insurance carrier an option to prohibit, the provider from contracting with another health insurance carrier to provide health care services at a rate that is equal to or lower than the payment specified in the contract.
(2) Require the provider to accept a lower payment rate in the event that the provider agrees to provide health care services to any other health insurance carrier at a rate that is equal to or lower than the payment specified in the contract.
(3) Require, or grant a health insurance carrier an option to require, termination or renegotiation of an existing health care contract in the event that the provider agrees to provide health care services to any other health insurance carrier at a rate that is equal to or lower than the payment specified in the contract.
(4) Require, or grant a health insurance carrier an option to require, the provider to disclose, directly or indirectly, the provider's contractual rates with another health insurance carrier.
(5) Require, or grant a health insurance carrier an option to require, the nonnegotiated adjustment by the issuer of the provider's contractual rate to equal the lowest rate the provider has agreed to charge any other health insurance carrier.
(6) Require, or grant a health insurance carrier an option to require, the provider to charge another health insurance carrier a rate that is equal to or more than the reimbursement rate specified in the contract. (2013-46, s. 1.)
Structure North Carolina General Statutes
North Carolina General Statutes
Article 50 - General Accident and Health Insurance Regulations.
§ 58-50-1 - Waiver by insurer.
§ 58-50-15 - Conforming to statute.
§ 58-50-25 - Nurses' services.
§ 58-50-26 - Physician services provided by physician assistants.
§ 58-50-30 - Right to choose services of certain providers.
§ 58-50-35 - Notice of nonpayment of premium required before forfeiture.
§ 58-50-45 - Group health or life insurers to notify insurance fiduciaries of obligations.
§ 58-50-46 - Recodified as G.S108A-55.4 by Session Laws 2006-221, s9(a), effective January 1, 2007.
§ 58-50-56 - Insurers, preferred provider organizations, and preferred provider benefit plans.
§ 58-50-56.1 - Exclusive provider organizations, exclusive provider benefit plans.
§ 58-50-56.2 - Exclusive provider organization continuity of care.
§ 58-50-57 - Offsets against provider reimbursement for workers' compensation payments forbidden.
§ 58-50-61 - Utilization review.
§ 58-50-62 - Insurer grievance procedures.
§ 58-50-63 - Expired pursuant to Session Laws 2005-453, s3, effective July 1, 2005.
§ 58-50-65 - Certain policies of insurance not affected.
§ 58-50-70 - Punishment for violation.
§ 58-50-75 - Purpose, scope, and definitions.
§ 58-50-77 - Notice of right to external review.
§ 58-50-79 - Exhaustion of internal grievance process.
§ 58-50-80 - Standard external review.
§ 58-50-82 - Expedited external review.
§ 58-50-84 - Binding nature of external review decision.
§ 58-50-85 - Approval of independent review organizations.
§ 58-50-87 - Minimum qualifications for independent review organizations.
§ 58-50-89 - Hold harmless for Commissioner and independent review organizations.
§ 58-50-90 - External review reporting requirements.
§ 58-50-92 - Funding of external review.
§ 58-50-93 - Disclosure requirements.
§ 58-50-94 - Selection of independent review organizations.
§ 58-50-100 - Title and reference.
§ 58-50-105 - Purpose and intent.
§ 58-50-112 - Affiliated companies; HMOs.
§ 58-50-115 - Health benefit plans subject to Act.
§ 58-50-125 - Health care plans; formation; approval; offerings.
§ 58-50-130 - Required health care plan provisions.
§ 58-50-131 - Premium rates for health benefit plans; approval authority; hearing.
§ 58-50-149 - Limit on cessions to the Reinsurance Pool.
§ 58-50-150 - North Carolina Small Employer Health Reinsurance Pool.
§ 58-50-275 - Notice contact provisions.
§ 58-50-280 - Contract amendments.
§ 58-50-285 - Policies and procedures.
§ 58-50-292 - Dental provider networks; confidential business information.
§ 58-50-295 - Prohibited contract provisions related to reimbursement rates.