Does It Count? · Indiana

Check the plan before you check the payment.

Indiana's law does not reach every health plan. Start with funding status, then use the four conditions to prepare questions for your plan. KnownCost does not determine whether a payment qualifies.

Question one

Where do you live?

State laws differ. Start here so KnownCost routes you to the right questions.

State

Question two

Who takes the risk for your plan?

Choose the closest answer. This is a routing check, not an eligibility determination.

Plan funding typeI bought the plan myselfHealthCare.gov or directly from an insurerMy employer says it is fully insuredThe insurer takes the claims riskState of Indiana employee planThe statute names this planMy employer says self-fundedThe employer pays claims; a carrier may administer themMy employer says level-fundedOften sold to smaller employersMedicare, Medicaid, TRICARE, or limited coverageAlso includes health-sharing and fixed-indemnity coverageI do not knowThe carrier logo on the card is not enough to tell

Only after the plan check

The four payment conditions

If the plan is Indiana-regulated, ask it to confirm each condition in writing before paying.

Direct paymentYou pay the provider yourself.
Covered careThe service is medically necessary and covered by the plan.
Claim not submittedThe provider confirms in writing that a claim for the service will not be submitted to your health plan, the payment is accepted in full, and there will be no later balance bill.
Below the benchmarkThe amount is below the average discounted rate. Indiana law lets you use Indiana APCD information to determine that rate; confirm the plan's process in writing.

Prepare, do not submit

Build your own document checklist.

The kit helps you organize a written quote, receipt, superbill, and plan correspondence. It does not transmit documents or contact an insurer.

Open the document kit Read the Indiana workflow