Indiana law requires notices and limits fees in out-of-network disputes

An initiating party must send written notice to the facility after requesting federal independent dispute resolution. An initiating party is a health carrier or out-of-network provider that requests federal independent dispute resolution. The notice must include a copy of the request form. Failure to give notice may lead to enforcement, but does not remove the duty to take part in any required conference and good-faith negotiation. The notice is due no later than three business days after the request is submitted.

A health carrier may notify the out-of-network provider and facility and call for good-faith negotiations. The negotiations involve the carrier, out-of-network provider, and facility named in the carrier's notice. This applies when one initiating party submits requests that include at least 25 distinct services or items during any 90-day period. If the carrier sends notice, the carrier, provider, and facility must try to resolve the issues through at least one meeting and a reasonable exchange of information. The meeting cannot decide individual claims or change legal rights, and it can happen no more than once per calendar quarter. A written meeting summary must be filed with the department; it is informational only, cannot require payment or penalties, and keeps claim-specific payment details confidential. If the carrier sends notice, the parties must make good-faith efforts to negotiate within 30 days.

A health carrier may not charge a facility or provider an administrative fee or penalty tied to care involving an out-of-network provider. This applies to care for an individual that involves an out-of-network provider. A carrier that imposes such a fee or penalty commits an unfair insurance practice and may face state insurance law penalties and procedures.