Out-of-network Provider Reimbursement Rate
The act corrects the reimbursement rate specified in law that a health insurance carrier is required to reimburse an out-of-network health care provider who provides either emergency services to a covered person or covered nonemergency services to a covered person at an in-network facility so that the law accurately states the reimbursement rate as the greater of:
- 110% of the carrier's median in-network rate of reimbursement; or
- The sixtieth percentile of the in-network rate of reimbursement for the same service in the same geographic area for the prior year based on claims from the all-payer health claims database.
(Note: This summary applies to this bill as enacted.)