(a)An insurer may:
(1)enter into agreements with providers relating to terms and
conditions of reimbursement for health care services that may be
rendered to insureds of the insurer, including agreements relating
to the amounts to be charged the insured for services rendered or
the terms and conditions for activities intended to reduce
inappropriate care;
(2)issue or administer policies in this state that include incentives
for the insured to utilize the services of a provider that has entered
into an agreement with the insurer under subdivision (1); and
(3)issue or administer policies in this state that provide for
reimbursement for expenses of health care services only if the
services have been rendered by a provider that has entered into an
agreement with the insurer under subdivisi
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(a) An insurer may:
(1) enter into agreements with providers relating to terms and
conditions of reimbursement for health care services that may be
rendered to insureds of the insurer, including agreements relating
to the amounts to be charged the insured for services rendered or
the terms and conditions for activities intended to reduce
inappropriate care;
(2) issue or administer policies in this state that include incentives
for the insured to utilize the services of a provider that has entered
into an agreement with the insurer under subdivision (1); and
(3) issue or administer policies in this state that provide for
reimbursement for expenses of health care services only if the
services have been rendered by a provider that has entered into an
agreement with the insurer under subdivision (1).
(b) Before entering into any agreement under subsection (a)(1), an
insurer shall establish terms and conditions that must be met by
providers wishing to enter into an agreement with the insurer under
subsection (a)(1). These terms and conditions may not discriminate
unreasonably against or among providers. For the purposes of this
subsection, neither differences in prices among hospitals or other
institutional providers produced by a process of individual negotiation
nor price differences among other providers in different geographical
areas or different specialties constitutes unreasonable discrimination.
Upon request by a provider seeking to enter into an agreement with an
insurer under subsection (a)(1), the insurer shall make available to the
provider a written statement of the terms and conditions that must be
met by providers wishing to enter into an agreement with the insurer
under subsection (a)(1).
(c) No hospital, physician, pharmacist, or other provider designated
in IC 27-8-6-1 willing to meet the terms and conditions of agreements
described in this section may be denied the right to enter into an
agreement under subsection (a)(1). When an insurer denies a provider
the right to enter into an agreement with the insurer under subsection
(a)(1) on the grounds that the provider does not satisfy the terms and
conditions established by the insurer for providers entering into
agreements with the insurer, the insurer shall provide the provider with
a written notice that:
(1) explains the basis of the insurer's denial; and
(2) states the specific terms and conditions that the provider, in
the opinion of the insurer, does not satisfy.
(d) In no event may an insurer deny or limit reimbursement to an
insured under this chapter on the grounds that the insured was not
referred to the provider by a person acting on behalf of or under an
agreement with the insurer.
(e) No cause of action shall arise against any person or insurer for:
(1) disclosing information as required by this section; or
(2) the subsequent use of the information by unauthorized
individuals.
Nor shall such a cause of action arise against any person or provider for
furnishing personal or privileged information to an insurer. However,
this subsection provides no immunity for disclosing or furnishing false
information with malice or willful intent to injure any person, provider,
or insurer.
(f) Nothing in this chapter abrogates the privileges and immunities
established in IC 34-30-15 (or IC 34-4-12.6 before its repeal).
(g) This subsection does not apply to a rate schedule maintained by
state or federal government payers. An insurer that enters into an
agreement with a provider under subsection (a)(1) must provide the
provider a current reimbursement rate schedule:
(1) every two (2) years; and
(2) when three (3) or more CPT code (as defined in IC 27-1-37.5-3) rates under the agreement are changed in a twelve
(12) month period.