§ 26.1-17-16 — Services of physicians, oral surgeons, dentists, and practitioners not participating under health service plan

participating under health service plan.
A medical service plan may provide for medical services to subscribers by physicians and
oral surgeons not participating under the plan, subject to the approval of the board of directors
of the health service corporation. A dental service plan may provide for dental services to
subscribers by dentists not participating under the plan, subject to the approval of the board of
directors of the health service corporation. An optometric service plan may provide for
optometric services to subscribers by practitioners not participating under the plan, subject to
the approval of the board of directors of the health service corporation.
When a subscriber patient is referred by a participating physician to a nonparticipating
physician, the health service corporation is to pay, without the approval of the board of directors
of the corporation, to the subscriber, upon proper filing of the claim, an amount equal to ninety
percent of the maximum amount which the corporation would be obligated to pay to a
participating physician for identical service. If a participating physician refers a patient to a
nonparticipating physician, the referring physician shall inform the patient that the physician to
whom the referral is being made is nonparticipating and this may result in the patient being
subject to charges greater than those to which the patient would be subject if the patient were
being treated by a participating provider. The health service corporation shall provide a listing of
all participating physicians to all participating physicians annually. The corporation shall provide
monthly updates of the listing of the nonparticipating providers.