ambulance providers. 1. In addition to the other preferred provider arrangement requirements under this chapter, a preferred provider arrangement must require the health care insurer and health care provider comply with this section. 2. Except as otherwise provided under this section, before a health care provider arranges for air ambulance services for an individual the health care provider knows to be a covered person, the health care provider shall request a prior authorization from the covered person's health care insurer for the air ambulance services to be provided to the covered pe rson. If the health care provider is unable to request or obtain pr ior authorization from the covered person's health care insurer: a. The health care provider shall provide the covered person or the covered person's authorized representative an out -of-network services written disclosure stating the following: (1) Certain air ambulance providers may be called upon to render care to the covered person during the course of treatment; (2) These air ambulance providers might not have contracts with the covered person's health care insurer and are, therefore, considered to be out of network; (3) If these air ambulance providers do not have contracts with the covered person's health care insurer, the air ambulance services will be provided on an out-of-network basis; (4) A description of the range of the charges for the out -of-network air ambulance services for which the covered person may be responsible; (5) A notification the covered person or the covered person's authorized representative may agree to accept and pay the charges for the out-of-network air ambulance services, contact the covered person's health care insurer for additional assistance, or rely on other rights and remedies that may be available under state or federal law; and (6) A statement indicating the covered person or the covered person's authorized representative may obtain a list of air ambulance providers from the covered person's health care insurer which are preferred providers and the covered person or the covered person's representative may request those participating air ambulance providers be accessed by the health care provider. b. Before air ambulance services are accessed for the covered person, the health care provider shall provide the covered person or the covered person's authorized representative the written disclosure, as outlined by subdivision a and obtain the covered person's or the covered person's authorized representative's signature on the disclosure document acknowledging the covered person or the covered person's authorized representative received the disclosure document before the air ambulance services were accessed. If the health care provider is unable to provide the written disclosure or obtain the signature required under this subdivision, the health care provider shall document the reason, which may include the health and safety of the patient. The health care provider documentation satisfies the requirement under this subdivision. 3. The rights and remedies provided under this section to covered persons are in addition to and may not preempt any other rights and remedies available to covered persons under state or federal law. 4. The department shall enforce this section and shall report a violation of this section by a facility to the department of health and human services. 5. This section does not apply to a policy or certificate of insurance, whether written on a group or individual basis, which provides coverage limited to: a. A specified disease, a specified accident, or accident-only coverage; b. Credit; c. Dental; d. Disability; e. Hospital; f. Long-term care insurance as defined by chapter 26.1-45; g. Vision care or any other limited supplemental benefit; h. A Medicare supplement policy of insurance, as defined by the commissioner by rule or coverage under a plan through Medicare; i. Medicaid; j. The federal employees health benefits program and any coverage issued as a supplement to that coverage; k. Coverage issued as supplemental to liability insurance, workers' compensation, or similar insurance; or l. Automobile medical payment insurance. 6. A health care provider is exempt from complying with this section if the health care provider determines and documents that due to emergency circumstances, compliance might jeopardize the health or safety of the patient. 7. The commissioner may adopt rules to implement this section.
‹ Prev All North Dakota sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.