Bureau of Insurance Bulletin 430: Requirement to Accept Referrals from Out-of-Network Providers

Bulletin 430, July 13, 2018 – Maine’s Bureau of Insurance published guidance to insurance carriers about how the Bureau intends to interpret recently-enacted (1/1/2018) 24‑A M.R.S. § 4303(22), which prohibits a carrier from denying payment for covered services based solely on the fact that the referring provider was out-of-network.  This means if your out of network physician refers you for physical therapy to a practice that is in-network with your health plan, your insurance carrier cannot require you to get the PT referral from a different in-network physician or deny your claims just because your physician is out of network.  Note that this law only applies to fully insured health plans (including HMOs) that are governed by state laws.  Self-insured health plans are not governed by state laws. Consult your health plan policy to determine what type of policy you have.  NEPPN’s members lobbied hard for this law to be passed in 2017.  We’re very pleased to see that the Bureau of Insurance is enforcing this law to protect consumers!