Payments to out-of-network providers for treatment of mental health or alcohol or substance use disorder.
1.Every payment made pursuant to a policy of health insurance to pay for treatment relating solely to mental health or an alcohol or substance use disorder must be made directly to the provider of health care that provides the treatment if the provider:
(a)Is an out-of-network provider; and
(b)Has obtained and delivered to the insurer or an authorized representative of the insurer, including, without limitation, a third-party administrator, a written assignment of benefits pursuant to which the insured has assigned to the provider the insured’s benefits under the policy of health insurance with regard to the treatment.
2.An out-of-network provider that receives payment pursuant to subsection 1:
(a)Shall, if a person paid the provider directly for the treatment described in subsection 1, refund to the person the amount that the person paid directly to the provider for the treatment, less any applicable deductible, copayment or coinsurance, not later than 45 days after the provider receives payment pursuant to subsection 1; and
(b)Must indemnify and hold harmless the insurer against any claim made against the insurer by the person who receives the treatment described in subsection 1 for any amount paid by the insurer to the provider in compliance with this section.
3.An assignment of benefits described in paragraph (b) of subsection 1 is irrevocable for the period:
(a)Beginning on the date the insured gives to the out-of-network provider the assignment of benefits; and
(b)Ending on the later of:
(1)The date on which the out-of-network provider receives from the insurer the final payment for the treatment; or
(2)The date of the final resolution, including, without limitation, by settlement or trial, of all claims relating to all payments which relate to the treatment.
4.Nothing in this section shall be construed to require an insurer to make a payment to an out-of-network provider:
(a)Who is not authorized by law to provide the treatment;
(b)Who provides the treatment in violation of any law; or
(c)In an amount which exceeds the amount required by the policy of health insurance to be paid for out-of-network treatment.
5.As used in this section:
(a)“Health care services” means services for the diagnosis, prevention, treatment, care or relief of a health condition, illness, injury or disease.
(b)“Insured” means a person who receives benefits pursuant to a policy of health insurance.
(c)“Insurer” means a person, including, without limitation, a governmental entity, who issues or otherwise provides a policy of health insurance.
(d)“Network plan” has the meaning ascribed to it in NRS 689B.570.
(e)“Out-of-network provider” means a provider of health care who:
(1)Provides health care services;
(2)Is paid, pursuant to a policy of health insurance, for providing the health care services; and
(3)Is not under contract to provide the health care services as part of any network plan associated with the policy of health insurance.
(f)“Policy of health insurance” includes, without limitation, a policy, contract, certificate, plan or agreement, as applicable, issued pursuant to or otherwise governed by NRS 287.0402 to 287.049, inclusive, or chapter 608, 689A, 689B, 689C, 695A, 695B, 695C, 695F or 695G of NRS for the provision of, delivery of, arrangement for, payment for or reimbursement for any of the costs of health care services.
(g)“Provider of health care” has the meaning ascribed to it in NRS 695G.070.
Section 687B.409 — Payments to out-of-network providers for treatment of mental health or alcohol or substance use disorder.,