58-17H-8. Cost-sharing requirements for covered persons--Payments to out-of-network providers.
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/sd/title-58/chapter-58-17/58-17h-8·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Notwithstanding § 58-17H-7 , a covered person may be required to pay, in addition to the in-network cost-sharing, the excess of the amount the out-of-network provider charges over the amount the health carrier is required to pay pursuant to this section.
A health carrier complies with the requirements of this section if it provides payment of emergency services provided by an out-of-network provider in an amount not less than the greatest of the following:
(1)The amount negotiated with in-network providers for emergency services, excluding any in-network copayment or coinsurance imposed with respect to the covered person;
(2)The amount of the emergency service calculated using the same method the plan uses to determine payments for out-of-network services, but using the in-network cost-sharing provisions instead of the out-of-network cost-sharing provisions; or
(3)The amount that would be paid under Medicare for the emergency services, excluding any in-network copayment or coinsurance requirements.