02-031-365 Me. Code R. § 2

Current through 2024-46, November 13, 2024
Section 031-365-2 - Applicability and Scope
1. This rule shall apply to the following entities:
A. A carrier, including a participating self-insured health plan.
B. A patient who is eligible to initiate IDR under 22 M.R.S. §1718-D.
C. A provider that has rendered emergency services to an eligible patient, or that has rendered emergency services on an out-of-network basis to a patient covered by a carrier's health plan and is unable in good faith to negotiate agreement with the carrier on the payment amount within 30 calendar days after the carrier has given the provider notice as required in paragraph 6(1)(C).
2. This rule shall apply to the following types of bills, except in cases where the patient knowingly elected to obtain the services from an out-of-network provider:
A. A surprise bill for emergency services;
B. Any other bill for covered emergency services rendered by an out-of-network provider to a person covered by an insured or self-insured health plan; and
C. A bill totaling $750 or more received by an uninsured person for emergency health services if the total bill for the single visit is $750 or more regardless of the number of providers included in the bill.

02-031 C.M.R. ch. 365, § 2