Ohio § 1751.60

§ 1751.60.

(A) Except as provided for in divisions (E) and (F) of this section, every provider or

health care facility that contracts with a health insuring corporation to provide

health care services to the health insuring corporation's enrollees or subscribers

shall seek compensation for covered services solely from the health insuring corporation

and not, under any circumstances, from the enrollees or subscribers, except for approved

copayments and deductibles. (B) No subscriber or enrollee of a health insuring corporation is liable to any contracting

provider or health care facility for the cost of any covered health care services,

if the subscriber or enrollee has acted in accordance with the evidence of coverage. (C) Except as provided for in divisions (E) and (F) of this section, every contract between

a health insuring corporation and provider or health care facility shall contain a

provision approved by the superintendent of insurance requiring the provider or health

care facility to seek compensation solely from the health insuring corporation and

not, under any circumstances, from the subscriber or enrollee, except for approved

copayments and deductibles. (D) Nothing in this section shall be construed as preventing a provider or health care

facility from billing the enrollee or subscriber of a health insuring corporation

for noncovered services. (E) Upon application by a health insuring corporation and a provider or health care facility,

the superintendent may waive the requirements of divisions (A) and (C) of this section

when, in addition to the reserve requirements contained in section 1751.28 of the Revised Code , the health insuring corporation provides sufficient assurances to the superintendent

that the provider or health care facility has been provided with financial guarantees.  No waiver of the requirements of divisions (A) and (C) of this section is effective

as to enrollees or subscribers for whom the health insuring corporation is compensated

under a provider agreement or risk contract entered into under the medicaid program. (F) The requirements of divisions (A) to (C) of this section apply only to health care

services provided to an enrollee or subscriber prior to the effective date of a termination

of a contract between the health insuring corporation and the provider or health care

facility.