Coverage for inadvertent out-of-network emergency services
a. If a covered person receives inadvertent out-of-network services or medically necessary services at an in-network or out-of-network health care facility on an emergency or urgent basis as defined by the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd et seq. and section 14 of P.L.1992, c.160 (C.26:2H-18.64), the health care professional performing those services shall:
(1) in the case of inadvertent out-of-network services, not bill the covered person in excess of any deductible, copayment, or coinsurance amount; and
(2) in the case of emergency and urgent services, not bill the covered person in excess of any deductible, copayment, or coinsurance amount, applicable to in-network services pursuant to the covered person’s health benefits plan.
b. If the carrier and the professional cannot agree on a reimbursement rate for the services provided pursuant to subsection a. of this section, pursuant to section 9 [C.26:2SS-9] of this act the carrier, professional, or covered person, as applicable, may initiate binding arbitration pursuant to section 10 or 11 [C.26:2SS-10 or 26:2SS-11] of this act.
c. This section shall only apply to providers providing services to members of entities providing or administering a self-funded health benefits plan and its plan members if the entity elects to be subject to section 9 [C.26:2SS-9] of this act pursuant to subsection d. of that section.