Indiana Code 27-2-25-12. Request for good faith estimate; requirements; notice; provision of information from practitioner and provider facility
(1) the amount of the cost of the nonemergency health care service that the health carrier will:
Terms Used In Indiana Code 27-2-25-12
- coverage: means the right of an individual to receive:
Indiana Code 27-2-25-1
- covered individual: means an individual who is entitled to coverage from a health carrier. See Indiana Code 27-2-25-2
- good faith estimate: means a health carrier's reasonable estimate of:
Indiana Code 27-2-25-3
- health carrier: means an entity:
Indiana Code 27-2-25-4
- in network: when used in reference to a practitioner, means that the health care services provided by the practitioner are subject to a health carrier's network plan. See Indiana Code 27-2-25-5
- network: means a group of provider facilities and practitioners that:
Indiana Code 27-2-25-6
- nonemergency health care service: means a discrete service or series of services ordered by a practitioner for an episode of care for the:
Indiana Code 27-2-25-8
- practitioner: means :
Indiana Code 27-2-25-9
- provider: means :
Indiana Code 27-2-25-10
- provider facility: means any of the following:
Indiana Code 27-2-25-11
(B) reimburse to;
the covered individual; or
(2) the applicable benefit limitations of the ordered nonemergency health care service a covered individual is entitled to receive from the health carrier.
(b) If:
(1) a health carrier provides coverage to a covered individual through a network plan; and
(2) the health carrier receives a request for a good faith estimate from a covered individual for whom a nonemergency health care service has been ordered;
the health carrier shall inform the covered individual whether the provider facility in which the nonemergency health care service will be provided is in network and whether each scheduled practitioner who may provide the nonemergency health care service is in network.
(c) A health carrier that receives a request from a covered individual patient under subsection (b) shall, not more than five (5) business days after receiving relevant information, provide to the individual a good faith estimate as described in section 14 of this chapter.
(d) A health carrier must ensure that a good faith estimate states that the estimate provided under this section is only valid for thirty (30) days and that:
(1) the amount that the health carrier will:
(A) pay; or
(B) reimburse;
for or to the covered individual for the nonemergency health care services the individual receives; and
(2) the applicable benefit limitations of the nonemergency health care services the individual will receive;
may vary from the health carrier’s good faith estimate based on the individual’s medical needs.
(e) A health carrier may not charge an individual for information provided under this section.
(f) A practitioner and provider facility shall provide a health carrier with the information needed by the health carrier to comply with the requirements under this chapter not more than two (2) business days after receiving the request.
As added by P.L.93-2020, SEC.13.