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Indiana Code Title 25. Professions and Occupations § 25-1-9.1-12

Current as of January 02, 2024 | Updated by Findlaw Staff

Sec. 12. (a) This section does not apply to a referral made by a provider that has confirmed that the provider to which a covered individual is referred is a network provider with respect to the covered individual's health plan.

(b) A provider that makes a referral shall provide to the covered individual an electronic or paper copy of written notice that states all of 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):

(A) to obtain a list of network providers that may render the health care items or services;  and

(B) for additional assistance.

(c) A provider that makes a referral via telephone to a patient of record shall provide to the covered individual all of the following information:

(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):

(A) to obtain a list of network providers that may render the health care items or services;  and

(B) for additional assistance.

(4) The provider shall note in the covered individual's medical chart:

(A) the name of the provider to whom the covered individual was referred;  and

(B) that the referral was made via telephone.

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Cite this article: FindLaw.com - Indiana Code Title 25. Professions and Occupations § 25-1-9.1-12 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-25-professions-and-occupations/in-code-sect-25-1-9-1-12/

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