Out-of-network Health Care Services

Health insurance - out-of-network health care services - disclosures - claims - reimbursement rates - deceptive trade practice - rules - appropriation. The act:

• Requires health insurance carriers, health care providers, and health care facilities to provide patients covered by health benefit plans with information concerning the provision of services by out-of-network providers and in-network and out-of-network facilities;
• Outlines the disclosure requirements and the claims and payment process for the provision of out-of-network services;
• Requires the commissioner of insurance, the state board of health, and the director of the division of professions and occupations in the department of regulatory agencies to promulgate rules that specify the requirements for disclosures to consumers, including the timing, the format, and the contents and language in the disclosures;
• Establishes the reimbursement amount for out-of-network providers that provide health care services to covered persons at an in-network facility and for out-of-network providers or facilities that provide emergency services to covered persons; and
• Creates a penalty for failure to comply with the payment requirements for out-of-network health care services.

The act appropriates $33,884 from the general fund to the department of public health and environment and $63,924 from the division of insurance cash fund to the division of insurance to implement the act.

Specified provisions of the act are contingent upon House Bill 19-1172 becoming law.

(Note: This summary applies to this bill as enacted.)