Neb. Rev. Stat. § 71-9507

(1) A direct agreement is not insurance and is not subject to Chapter 44. (2) Neither a direct provider nor an agent of a direct provider is required to obtain a certificate of authority or license under Chapter 44 to market, sell, or offer to sell a direct agreement. (3) A direct provider shall not bill an insurer for services provided under a direct agreement. A patient may submit a request for reimbursement to an insurer if permitted under a policy of insurance. This subsection does not prohibit a direct provider from billing insurance for services not provided under a direct agreement.