20-242. Health insurers; provider networks; notice; options; definitions

A. If a health insurer acquires the provider network of another health insurer, the health insurer that is contracted with a health care provider in the network that has been acquired shall notify, consistent with the notification provisions of the provider contract, each health care provider of the acquired network.

B. A health care provider that is in a provider network that is acquired may do any of the following:

1. Continue the provider relationship with the health insurer that acquired the provider network.

2. Terminate the provider relationship with the health insurer that acquired the provider network in a time and manner consistent with the contract between the health care provider and the health insurer that is contracted with the health care provider.

3. Enter into a contract directly with the health insurer that acquired the provider network.

C. This section does not apply to acquisitions or arrangements that are disclosed in the network contract between a health care provider and a health insurer and to which the health care provider has already agreed.

D. For the purposes of this section:

1. " Health care provider" means a person who is licensed, registered or certified as a health care professional under title 32 or a laboratory or durable medical equipment provider that furnishes services to an enrollee and that separately bills the enrollee for the services.

2. " Health insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital, medical, dental and optometric service corporation and includes the health insurer's designee.