Tennessee § 56-7-610 Enrollee price negotiation for out of pocket services

Tennessee Statutes

§ 56-7-610 — Enrollee price negotiation for out of pocket services

Tennessee § 56-7-610

Title56

This text of Tennessee § 56-7-610 (Enrollee price negotiation for out of pocket services) is published on Counsel Stack Legal Research, covering Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Tenn. Code Ann. § 56-7-610 (2026).

Text

(a)An enrollee may choose to pay for a healthcare service out-of-pocket from an out-of-network provider. If an enrollee negotiates for a lower cost from an out-of-network provider than the average allowed amount paid by the carrier to a network provider for a comparable healthcare service, and the enrollee pays for the healthcare service out-of-pocket, then the enrollee may send documentation, which may be sent electronically, to the carrier, that provides the following:

(1)The healthcare service the enrollee or patient received and the healthcare provider's name and contact information;

(2)The order from the healthcare provider given to the enrollee or patient pursuant to § 56-7-605 and the final bill or statement for the healthcare service;

(3)The average payments made by the carrier

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(a) An enrollee may choose to pay for a healthcare service out-of-pocket from an out-of-network provider. If an enrollee negotiates for a lower cost from an out-of-network provider than the average allowed amount paid by the carrier to a network provider for a comparable healthcare service, and the enrollee pays for the healthcare service out-of-pocket, then the enrollee may send documentation, which may be sent electronically, to the carrier, that provides the following: (1) The healthcare service the enrollee or patient received and the healthcare provider's name and contact information; (2) The order from the healthcare provider given to the enrollee or patient pursuant to § 56-7-605 and the final bill or statement for the healthcare service; (3) The average payments made by the carrier to network entities or providers for comparable healthcare services if this information is made available to the enrollee pursuant to this part; (4) The negotiated cost of the healthcare service that the enrollee received; and (5) A statement that: (A) The enrollee paid out-of-pocket for the healthcare services received; and (B) The healthcare entity is not making a claim against the carrier for payment for the healthcare service provided to the enrollee or patient. (b) A carrier that receives the documentation described in subsection (a) shall count the full amount that the enrollee paid out-of-pocket toward the enrollee's deductible, coinsurance, copayment, or other cost-sharing amount: (1) If the healthcare service is included under the enrollee's health plan; and (2) The enrollee negotiated for a lower cost for the healthcare service than the average allowed amount paid by the carrier to network providers for that comparable healthcare service. (c) The amount counted toward an enrollee's out-of-pocket deductible, coinsurance, copayment, or other cost-sharing amount must not exceed the total amount that the covered person is required to pay out-of-pocket during a contractually agreed upon period of time for healthcare services that are included under the covered person's insurance plan, and does not carry over once a new contract or agreement period for the insurance plan begins.