Indiana Code 25-1-9.8-12. In network good faith estimates; out of network good faith estimates
(1) the individual who requests a good faith estimate from a practitioner under this chapter is a covered individual with respect to a network plan; and
Terms Used In Indiana Code 25-1-9.8-12
- covered individual: means an individual who is entitled to be provided health care services according to a health carrier's network plan. See Indiana Code 25-1-9.8-1
- 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 25-1-9.8-2
- 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 25-1-9.8-4
- network: means a group of provider facilities and practitioners that:
Indiana Code 25-1-9.8-5
- network plan: means a plan of a health carrier that:
Indiana Code 25-1-9.8-6
- 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 25-1-9.8-7
- practitioner: means the following:
Indiana Code 25-1-9.8-8
- price: means the negotiated rate between the:
Indiana Code 25-1-9.8-8.5
- provider: means :
Indiana Code 25-1-9.8-9
the good faith estimate that the practitioner provides to the individual under this chapter must be based on the negotiated price to which the practitioner has agreed as an in network provider.
(b) If the individual who requests a good faith estimate from a practitioner under this chapter:
(1) is not a covered individual with respect to any network plan; or
(2) is not a covered individual with respect to a network plan with respect to which the practitioner is in network;
the good faith estimate that the practitioner provides to the individual under this chapter must be based on the price that the practitioner charges for the nonemergency health care service in the absence of any network plan.
As added by P.L.93-2020, SEC.7.