Sec. 14. (a) A good faith estimate provided by a practitioner to an individual under this chapter must meet the following requirements:

(1) Provide a summary of the services and material items that the good faith estimate is based on.

Terms Used In Indiana Code 25-1-9.8-14

  • episode of care: means the medical care ordered to be provided for a specific medical procedure, condition, or illness. See Indiana Code 25-1-9.8-1.5
  • 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 25-1-9.8-2

  • health carrier: means an entity:

    Indiana Code 25-1-9.8-3

  • 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

  • provider facility: means any of the following:

    Indiana Code 25-1-9.8-10

(2) Include:

(A) the price charged for the services and material items that the practitioner will provide and charge the individual; and

(B) the price that the provider facility in which the health care service will be performed charged for:

(i) the use of the provider facility to care for the individual for the nonemergency health care service;

(ii) the services rendered by the employed or contracted staff of the provider facility in connection with the nonemergency health care service; and

(iii) 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;

for imaging, laboratory services, diagnostic services, therapy, observation services, and other services expected to be provided to the individual for the episode of care.

(3) Include a total figure that is a sum of the estimated prices referred to in subdivisions (1) and (2).

     (b) Subsection (a) does not prohibit a practitioner from providing to an individual a good faith estimate that indicates how much of the total figure stated under subsection (a)(2) will be the individual’s out-of-pocket expense after the health carrier‘s payment of charges.

     (c) A health carrier and a provider facility must provide a practitioner with the information needed by the practitioner to comply with the requirements under this chapter not more than two (2) business days after receiving the request. The provider facility shall provide the practitioner with all relevant information for services and costs for the good faith estimate that are to be provided by the provider facility for inclusion in a good faith estimate by the practitioner.

     (d) A practitioner is not subject to the penalties under section 19 of this chapter if:

(1) a health carrier or provider facility fails to provide the practitioner with the information as required under subsection (c);

(2) the practitioner provides the individual with a good faith estimate based on any information that the practitioner has; and

(3) the practitioner provides the individual with an updated good faith estimate after the health carrier or provider facility has provided the information required under subsection (c).

As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.4.

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