4123-6-67 Payment in the QHP system - payment to providers in states that border Ohio

(A) Out-of-state providers that are certified by the bureau in states that border Ohio shall accept and be paid as payment in full in accordance with the Ohio workers' compensation state fee schedule or the amount billed, whichever is less, unless an alternate provider agreement exists between provider, and employer and/or the QHP. No health-care provider shall charge, assess, or otherwise attempt to collect from an employee, employer, a vendor, or a QHP, any amount for covered services or supplies that is in excess of the amount reimbursed by the employer, a vendor, or a QHP.

(B) An employer or QHP shall hold an employee harmless for all balanced billing from out-of-state providers in states that border Ohio and who are a member of a QHP panel or who have signed a provider agreement with a QHP and/or employer.

(C) Payment to out-of-state providers in states that border Ohio who are not certified by the bureau, in the absence of a provider agreement with an employer and/or QHP, shall be the sole responsibility of the employee unless otherwise authorized by the employer or QHP.