Nevada § 439B.751 - Payment to out-of-network provider, other than emergency facility, by third party

§ 439B.751. Payment to out-of-network provider, other than emergency facility, by third party

1. If an out-of-network provider, other than an out-of-network emergency facility,

had a provider contract as an in-network provider within the 12 months immediately

preceding the date on which the medically necessary emergency services were rendered

to a covered person and: (a) The out-of-network provider terminated the most recent applicable provider contract

between the third party that provides coverage for the covered person and the out-of-network

provider without cause before it was scheduled to expire, the third party shall pay

to the out-of-network provider for those services, and the out-of-network provider

shall accept as payment in full for those services, except for any copayment, coinsurance

or deductible that the coverage requires the covered person to pay for the services

when provided by an in-network provider, the amount that would have been paid for

those services pursuant to that provider contract, less the amount of the copayment,

coinsurance or deductible, if applicable. (b) The out-of-network provider terminated the most recent applicable provider contract

between the third party that provides coverage for the covered person and the out-of-network

provider for cause before it was scheduled to expire or the third party terminated

the contract without cause, the third party shall pay to the out-of-network provider

for those services, and the out-of-network provider shall accept as payment in full

for those services, except for any copayment, coinsurance or deductible that the coverage

requires the covered person to pay for the services when provided by an in-network

provider, 108 percent of the amount that would have been paid for those services pursuant

to the provider contract, less the amount of the copayment, coinsurance or deductible,

if applicable. (c) The third party that provides coverage for the covered person terminated the most

recent applicable provider contract between the third party and the out-of-network

provider for cause before it was scheduled to expire, the third party shall pay to

the out-of-network provider an amount that the third party has determined to be fair

and reasonable as payment for the medically necessary emergency services, except for

any copayment, coinsurance or deductible that the coverage requires the covered person

to pay for the services when provided by an in-network provider. (d) The contract was not terminated by either party, the third party that provides

coverage for the covered person shall pay to the out-of-network provider for those

services, and the out-of-network provider shall accept as payment in full for those

services, except for any copayment, coinsurance or deductible that the coverage requires

the covered person to pay for the services when provided by an in-network provider,

the amount that would have been paid for those services pursuant to the most recent

applicable provider contract between the third party and the out-of-network provider

plus an amount equal to the percentage of increase in the Consumer Price Index, Medical

Care Component, during the immediately preceding calendar year, less the amount of

the copayment, coinsurance or deductible, if applicable. 2. If an out-of-network provider, other than an out-of-network emergency facility,

did not have a provider contract as an in-network provider within the 12 months immediately

preceding the date on which the medically necessary emergency services were rendered

to a covered person, the third party that provides coverage to the covered person

shall submit to the out-of-network provider an offer of payment in full for the medically

necessary emergency services, except for any copayment, coinsurance or deductible

that the coverage requires the covered person to pay for the services when provided

by an in-network provider.