Indiana § 27-2-25-12 Request for good faith estimate; requirements; notice; provision of
information from practitioner and provider facility

Indiana Statutes

§ 27-2-25-12 — Request for good faith estimate; requirements; notice; provision of information from practitioner and provider facility

Indiana·Title 27 INSURANCE·Art. 2 POWERS AND DUTIES OF INSURERS·Ch. 25 Health Carrier Good Faith Estimates

(a)A covered individual may request from the health carrier a good faith estimate of:

(1)the amount of the cost of the nonemergency health care service that the health carrier will:

(A)pay for; or

(B)reimburse to; the covered individual; or

(2)the applicable benefit limitations of the ordered nonemergency health care service a covered individual is entitled to receive from the health carrier.

(b)If:

(1)a health carrier provides coverage to a covered individual through a network plan; and

(2)the health carrier receives a request for a good faith estimate from a covered individual for whom a nonemergency health care service has been ordered; the health carrier shall inform the covered individual whether the provider facility in which the nonemergency health care service will be provi

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(a) A covered individual may request from
the health carrier a good faith estimate of:
(1) the amount of the cost of the nonemergency health care
service that the health carrier will:
(A) pay for; or
(B) reimburse to;
the covered individual; or
(2) the applicable benefit limitations of the ordered nonemergency
health care service a covered individual is entitled to receive from
the health carrier.
(b) If:
(1) a health carrier provides coverage to a covered individual
through a network plan; and
(2) the health carrier receives a request for a good faith estimate
from a covered individual for whom a nonemergency health care
service has been ordered;
the health carrier shall inform the covered individual whether the
provider facility in which the nonemergency health care service will be
provided is in network and whether each scheduled practitioner who
may provide the nonemergency health care service is in network.
(c) A health carrier that receives a request from a covered individual
patient under subsection (b) shall, not more than two (2) business days
after receiving relevant information, provide to the individual a good
faith estimate as described in section 14 of this chapter.
(d) A health carrier must ensure that a good faith estimate states that
the estimate provided under this section is only valid for thirty (30)
days and that:
(1) the amount that the health carrier will:
(A) pay; or
(B) reimburse;
for or to the covered individual for the nonemergency health care
services the individual receives; and
(2) the applicable benefit limitations of the nonemergency health
care services the individual will receive;
may vary from the health carrier's good faith estimate based on the
individual's medical needs.
(e) A health carrier may not charge an individual for information
provided under this section.
(f) A practitioner and provider facility shall provide a health carrier
with the information needed by the health carrier to comply with the
requirements under this chapter not more than two (2) business days
after receiving the request.

Indiana § 27-2-25-12 (Request for good faith estimate; requirements; notice; provision of information from practitioner and provider facility) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.