215 Ill. Comp. Stat. § 5/356z.3a. Nonparticipating facility-based physicians and providers: Accident and Health Insurance – Illinois

Status: Enacted
Year Enacted: 2011
Year Amended: 2013
File: Download

When a beneficiary, insured, or enrollee utilizes a participating network hospital or a participating network ambulatory surgery center and, due to any reason, in network services for radiology, anesthesiology, pathology, emergency physician, or neonatology are unavailable and are provided by a nonparticipating facility-based physician or provider, the insurer or health plan shall ensure that the beneficiary, insured, or enrollee shall incur no greater out-of-pocket costs than the beneficiary, insured, or enrollee would have incurred with a participating physician or provider for covered services.

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