§36-1219.3. Discounted reimbursement and disclosure of
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reimbursement terms prohibited.
A. An insurer or third-party administrator shall not reimburse a health care provider on a discounted fee basis for covered services that are provided to an insured unless:
1. The insurer or third-party administrator has contracted with either:
a. the health care provider, or
b. a preferred provider organization which has contracted
with the health care provider;
2. The health care provider has agreed to provide health care services under the terms of the contract; and
3. The insurer or third-party administrator has agreed to provide coverage for those health care services under an accident and health insurance policy.
B. A party to a preferred provider contract, including a contract with a preferred provider organization, may not sell, lease, or otherwise transfer information regarding the payment or reimbursement terms of the contract without the express authority and prior adequate notification of the other contracting parties. Added by Laws 2000, c. 353, § 6, eff. Nov. 1, 2000.