HRS §431:10A-144
Who gets paid for required health services
This section says that when a health plan must cover certain services, the plan must pay the health care provider who did the service, or sometimes the insured person. A provider can only be paid if they are allowed to be paid under the plan and are working within their license. It also defines what counts as a health care provider.
The statute, as written — Reimbursement to providers
(a) Coverage for services required by this part shall include reimbursement to health care providers who perform services required by this part, or to the insured member, as appropriate. (b) Whenever an individual or group policy, contract, plan, or agreement provides for reimbursement for any service, a health care provider who performs a service shall be eligible for reimbursement for the performed service to the extent the health care provider is eligible for such reimbursement under the policy, contract, plan, or agreement, and is acting within the scope of the provider's license or certification under state law. (c) For purposes of this section, "health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u); a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s); and a practitioner licensed by the State and working within the practitioner's scope of practice.
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