Nebraska Statutes 44-32,141. Provider contracts; requirements
Every contract between a health maintenance organization and a participating provider shall be in writing and shall provide that, if the health maintenance organization fails to pay for health care services as set forth in the contract, the subscriber or enrollee will not be liable to the provider for any sum owed by the health maintenance organization. If the contract has not been reduced to writing or fails to contain the provision required by this section, the participating provider shall not collect or attempt to collect from the subscriber or enrollee sums owed by the health maintenance organization. No participating provider, or agent, trustee, or assignee of a participating provider, may maintain any action at law against a subscriber or enrollee to collect sums owed by the health maintenance organization.
Terms Used In Nebraska Statutes 44-32,141
- Action: shall include any proceeding in any court of this state. See Nebraska Statutes 49-801
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: shall mean an individual who is covered by a health maintenance organization and shall include both subscribers and dependents of subscribers. See Nebraska Statutes 44-3299
- Health maintenance organization: shall mean any person who undertakes to provide or arrange for the delivery of basic health care services to enrollees on a prepaid basis except for enrollee responsibility for copayments or deductibles. See Nebraska Statutes 44-32,105
- Participating provider: shall mean a provider who, under an express or implied contract with the health maintenance organization or with its contractor or subcontractor, has agreed to provide health care services to enrollees with an expectation of receiving payment, other than copayment or deductible, directly or indirectly from the health maintenance organization. See Nebraska Statutes 44-32,110
- Provider: shall mean any physician, hospital, or other person licensed or otherwise authorized to furnish health care services. See Nebraska Statutes 44-32,111
- Subscriber: shall mean an individual whose employment or other status, except family dependency, is the basis for eligibility for enrollment in the health maintenance organization or, in the case of an individual contract, the individual in whose name the contract is issued. See Nebraska Statutes 44-32,113
- Trustee: A person or institution holding and administering property in trust.