Indiana § 25-1-9.1-12 Notice to covered individual upon referral; notice for telephone referral

Indiana Statutes

§ 25-1-9.1-12 — Notice to covered individual upon referral; notice for telephone referral

Indiana § 25-1-9.1-12

Title 25PROFESSIONS AND OCCUPATIONS

Art. 1GENERAL PROVISIONS

Ch. 9.1Out of Network Provider Referrals

This text of Indiana § 25-1-9.1-12 (Notice to covered individual upon referral; notice for telephone referral) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 25-1-9.1-12 (2026).

Text

(a)This section does not apply to a referral made by a provider that has confirmed that the provider to which a covered individual is referred is a network provider with respect to the covered individual's health plan.

(b)A provider that makes a referral shall provide to the covered individual an electronic or paper copy of written notice that states all of the following:

(1)That an out of network provider may be called upon to render health care items or services to the covered individual during the course of treatment.

(2)That an out of network provider described in subdivision (1) 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.

(3)That the covered individual may contact the

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(a) This section does not apply to a referral
made by a provider that has confirmed that the provider to which a
covered individual is referred is a network provider with respect to the
covered individual's health plan.
(b) A provider that makes a referral shall provide to the covered
individual an electronic or paper copy of written notice that states all
of the following:
(1) That an out of network provider may be called upon to render
health care items or services to the covered individual during the
course of treatment.
(2) That an out of network provider described in subdivision (1)
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.
(3) That 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 described in
subdivision (1):
(A) to obtain a list of network providers that may render the
health care items or services; and
(B) for additional assistance.
(c) A provider that makes a referral via telephone to a patient of
record shall provide to the covered individual all of the following
information:
(1) That an out of network provider may be called upon to render
health care items or services to the covered individual during the
course of treatment.
(2) That an out of network provider described in subdivision (1)
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.
(3) That 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 described in
subdivision (1):
(A) to obtain a list of network providers that may render the
health care items or services; and
(B) for additional assistance.
(4) The provider shall note in the covered individual's medical
chart:
(A) the name of the provider to whom the covered individual
was referred; and
(B) that the referral was made via telephone.