Indiana Code 27-1-46-11. Right of individual to request good faith estimate from provider facility; duty of provider facility to provide estimate; required contents
(1) apply to an individual who is a Medicaid recipient; or
Terms Used In Indiana Code 27-1-46-11
- episode of care: means the medical care ordered to be provided for a specific medical procedure, condition, or illness. See Indiana Code 27-1-46-1.5
- good faith estimate: means a reasonable estimate of the price each provider anticipates charging for an episode of care for nonemergency health care services that:
Indiana Code 27-1-46-2
- nonemergency health care service: means a discrete service or series of services ordered by a practitioner for an episode of care for the purpose of:
Indiana Code 27-1-46-7
- price: means the negotiated rate between the:
Indiana Code 27-1-46-8.5
- provider: means :
Indiana Code 27-1-46-9
- provider facility: means any of the following:
Indiana Code 27-1-46-10
(b) An individual for whom a nonemergency health care service has been ordered, scheduled, or referred may request from the provider facility in which the nonemergency health care service will be provided a good faith estimate of the price that will be charged for the nonemergency health care service.
(c) A provider facility that receives a request from an individual under subsection (b) shall, not more than five (5) business days after receiving relevant information from the individual, provide to the individual a good faith estimate of:
(1) the price that the provider facility in which the health care service will be performed will charge for:
(A) the use of the provider facility to care for the individual for the nonemergency health care service;
(B) the services rendered by the employed or contracted staff of the provider facility in connection with the nonemergency health care service; and
(C) medication, supplies, equipment, and material items to be provided to or used by the individual while the individual is present in the provider facility in connection with the nonemergency health care service; and
(2) the price charged for the services of all practitioners, support staff, and other persons who provide professional health services:
(A) who may provide services to or for the individual during the individual’s presence in the provider facility for the nonemergency health care service; and
(B) for whose services the individual will be charged separately from the charge of the provider facility.
(d) The price that must be included in a good faith estimate under this section includes all services under subsection (c)(1) or (c)(2) for imaging, laboratory services, diagnostic services, therapy, observation services, and other services expected to be provided to the individual for the episode of care.
(e) A provider facility shall ensure that a good faith estimate states that:
(1) an estimate provided under this section is not binding on the provider facility;
(2) the price the provider facility charges the individual may vary from the estimate based on the individual’s medical needs; and
(3) the estimate provided under this section is only valid for thirty (30) days.
(f) A provider facility may not charge a patient for information provided under this section.
As added by P.L.93-2020, SEC.12. Amended by P.L.202-2021, SEC.13.