CREATING THE CLINICIAN OUT-OF-NETWORK ACT: If out-of-network services are provided to a patient by a clinician, the clinician shall bill the patient’s insurance carrier directly and the insurance carrier shall reimburse the clinician for the professional services as coded and billed by the clinician. Insurance carriers shall not apply deductibles and coinsurance for non-elective services. The allowed out-of-network benefit shall be reimbursed at an amount that is not less than the minimum benefit standard for clinicians as defined in Section 2 of this act.
Clinicians shall be prohibited from out-of-network balance billing except where notice and consent is obtained from the guarantor pursuant to these provisions for place-of-service 21 and 22 and except as provided in subsection A of this section. Notice and consent for opt-out-services shall be obtained at least twenty-four (24) hours in advance of the provision of out-of-network services and the clinicians’ notice shall be in advance of the guarantor’s admission