‘Surprise billing’ notice required as of Jan. 1
An Indiana law passed during the 2017 legislative session imposes a new notice requirement on physicians who refer patients to other providers (including entities that bill for health care items or services rendered by individual providers) beginning Jan. 1, 2018. Primary-care providers will be affected most, since they most often refer patients for services.

The new law was passed as House Bill (HB) 1273, “Out-of-Network Covered Health Services.” It requires referring physicians to provide patients with a written notice, on paper or electronically, 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.

 The notice requirement does not apply when:
  • the referral is for treating an emergency medical condition;
  • the referring physician is treating a patient for an emergency medical condition;
  • the referral is for services to an inpatient in a hospital;
  • the referral is to a physician in the same provider group as the referring physician or to a physician not specifically identified by name;
  • the referral is for a patient covered by Medicaid;
  • the referral is for a patient covered by workers’ compensation insurance; or
  • the referral is for a patient who is uninsured.
The text of HB 1273 can be found at www.ismanet.org/HB1273. For additional information or questions, ISMA members may contact General Counsel Stacy Cook, JD, LLM, at scook@ismanet.org, (317) 261-2060 or toll free at (800) 257-4762.