§ 58-3-175. Direct payment to government agencies. - North Carolina Statutes

§ 58‑3‑175. Direct payment to government agencies.

(a)        As used in thissection, "health benefit plan" has the same meaning as in G.S. 58‑50‑110(11)and includes the State Health Plan for Teachers and State Employees and anyoptional plans or programs operating under Part 2 of Article 3 of Chapter 135of the General Statutes.

(b)        Every entityproviding or administering a health benefit plan covering persons in this Stateshall make payment for health care services covered by the health benefit planthat are provided by any State, county, or city agency, directly to the agencyproviding the services.

(c)        This section doesnot apply to the extent the agency providing the services has been paid for theservices by or on behalf of the person receiving the services.

(d)        Nothing in thissection shall require any entity providing or administering a health benefitplan covering persons in this State to pay any agency directly:

(1)        If the agency isoutside of the health benefit plan's service area;

(2)        If the entity operatesa program by which it only pays the health care provider directly upon theacceptance of certain rates and the agency does not accept said rates; or

(3)        If the entityoperates a program by which it provides, authorizes, or arranges for a coveredperson to receive health care from a designated provider or refers the coveredperson to a designated provider, and the agency is not a designated provider. (1993, c. 41, s. 1; 2007‑298,s. 8.4; 2007‑323, s. 28.22A(o); 2007‑345, s. 12.)