An Act To Amend the Law Prohibiting the Denial by Health Insurers of Referrals by Out-of-network Providers

Sec. 1. 24-A MRSA §4303, sub-§22,  as enacted by PL 2017, c. 232, §7, is amended to read:

SUMMARY

This bill provides that the law that prohibits carriers from denying payment for covered health care services solely on the basis that the referral for services was made by an out-of-network provider applies only to referrals made by out-of-network direct primary care providers. It also allows a carrier to require a direct primary care provider who is not a member of the carrier's provider network and who makes a referral to meet appropriate credentialing standards consistent with other primary care providers participating in the carrier's provider network.