CHAPTER 358-T PROHIBITION ON BALANCE BILLING COVERED PERSONS FOR HEALTH CARE SERVICES
Section 358-T:3
358-T:3 Balance Billing in Cases of Non-emergency Services Performed by Nonparticipating Providers at Certain Participating Health Care Facilities. –
I. Subject to paragraph II, if a covered person is furnished health care items or services, other than emergency services, by a nonparticipating provider at a participating facility for which benefits are provided under the covered person's health benefit plan, then such provider shall not bill, and shall not hold liable, such covered person for a payment amount for such item or service furnished by such provider with respect to a visit at such facility that is more than the cost-sharing requirement for such item or service under the covered person's health benefit plan.
II. Paragraph I shall not apply with respect to items or services, other than items or services that qualify as ancillary services under 42 U.S.C. section 300gg-132(b)(2) and (3), furnished by a nonparticipating provider to a covered person if the provider satisfies the notice and consent criteria under 42 U.S.C. section 300gg-132(c) and (d).