Under the regulation, patients who use providers they believe are in-network based on misinformation provided by their insurers will not pay more than their in-network cost-sharing, according to a Dec. 7 news release from the governor’s office.
The regulation states that provider directory misinformation occurs when:
- A provider who does not participate in an insurer’s network is incorrectly listed as an in-network provider in the insurer’s online or hard copy provider directory.
- In response to a consumer’s request for information by telephone or via electronic means, an insurer indicates in writing that a provider is in-network when the provider is not in-network.
- An insurer fails to provide network status information in writing to a consumer within a certain number of days of the consumer’s request for such information by telephone or through electronic means
The regulation is consistent with the federal No Surprises Act, according to the release.
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