Indiana Law Change: Out of Network Provider Referrals

On April 24, 2017, the Indiana Governor signed into law a bill that specifies notice requirements for network health care providers that make referrals to out of network health care providers. Beginning after December 31, 2017, the new requirements apply to referrals made for any patient for any service outside the referring health care provider’s office or hospital practice.

Under the new law, the provider must supply a covered patient with an electronic or paper copy of written notice that states the following:

• That an out of network provider may be called upon to render health care items or services to the covered individual during treatment.
• The out of network provider is not bound by the payment provisions that apply to health care items or services rendered by a network provider under the covered individual’s health plan.
• The covered individual may contact the covered individual’s health plan before receiving health care items or services rendered by an out of network provider to obtain a list of network providers that may render the health care items or services and for additional assistance.

The new law does not apply to the following:

• A referral for treatment of an emergency medical condition.
• A referral made immediately following treatment of an emergency medical condition and by the provider that rendered the treatment of the emergency medical condition.
• A referral for medically or psychologically necessary therapeutic services rendered to an admitted patient in a hospital or another facility to which a patient may be admitted for more than twenty-four hours.

This new law can be viewed here.