State Law

Minnesota Statutes-Chapter 62C. Nonprofit Health Service Plan Corporations

08/09/2023 Minnesota Section 62C.18

Personal Liability

OON-Payment Issues

Subdivision 1.  Limitation. —  No participating provider shall have any right of action against a subscriber for compensation for health services which such provider has rendered, except to the extent that the subscriber’s contract does not provide coverage for the services or part of the services rendered.

Subd. 2.  Rights of nonparticipating providers; notice. —  Nothing herein shall affect the rights of a nonparticipating provider who gives the subscriber written notice prior to rendering service that the provider will bill the subscriber directly for service, provided that such notice shall not be required if (1) the nonparticipating provider is not informed by the subscriber and does not otherwise have knowledge that such subscriber has a subscriber contract covering such services, or (2) under the existing circumstances it is impossible or impractical for the nonparticipating provider to give such notice, or (3) the services are not provided in this state.

Subd. 3.  Failure of nonparticipating provider to give notice. —  A nonparticipating provider who fails to give the notice required in subdivision 2 shall not be entitled to recover compensation from a subscriber for health services rendered to such subscriber in an amount in excess of the aggregate of (1) the amount actually received by the subscriber from the service plan corporation as reimbursement for the costs of such service, and (2) the amount by which such nonparticipating provider’s fee or charges for such service exceeds the coverage provided for such service in the subscriber’s contract.