69O-191.049. Services of Specified Non-Contracted Hospital Based Physician Providers
Effective on Thursday, May 28, 1992
1(1) A subscriber of a HMO who is authorized to receive services from a hospital under contract with the HMO may not be denied medically necessary covered health care services or be responsible for payment to any physician provider, or agent thereof, other than payment for services which are not covered by the HMO subscriber contract or which the subscriber has requested or agreed to receive.
67(2) In the event the HMO has not contracted directly with a hospital based physician provider delivering services in the hospital, including, but not limited to, pathologists, radiologists, anesthesiologists, and emergency room physicians, the HMO shall pay for medically necessary and approved physician care rendered to a non-medicare subscriber at a contracted hospital which services are covered by the HMO subscriber contract.
