Delaware Billing Rights

Additional State-Law Protections for Patients with State-Regulated Health Plans

• Facility-based providers and health care providers may not balance bill covered patients for health care services not covered by an insured’s health insurance contract if they failed to provide certain written out-of-network disclosures to the covered person or failed to obtain consent from the patient prior to services.
• Prior to the delivery of non-emergency covered services to a covered person, an out-of-network health care providers must provide covered persons with a timely, written out-of-network disclosure prior to services.
• When a facility-based provider (a provider in an in-patient or ambulatory facility, including services such as pathology, anesthesiology, or radiology) or a health care provider requests a laboratory service for a covered person that does not require an in-person visit, the provider must provide certain disclosures to the covered person if the facility being utilized is an out-of-network facility. If the requesting provider does not provide the required disclosure to the covered person, the covered person may not be subject to any balance billing of the out-of-network service(s). If the laboratory service being requested requires an in-person visit, the laboratory must provide the covered person a written disclosure of the out-of-network service(s) and a consent form prior to rendering any service(s). If the laboratory does not provide the required disclosure to the covered person, the covered person shall not be subject to any balance billing.