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Out-of-network Provider Reimbursement Rate

Concerning a correction to the rate of reimbursement that an out-of-network health care provider is entitled to receive from a health insurance carrier for services provided to a covered person at an in-network facility when the health care provider submits a claim to the carrier within the specified time period to conform with existing law.
2020 Regular Session
Bill Summary

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.)


Became Law


Bill Text

  • All Versions (7 )
    Date Bill Type Documents
    03/11/2020 Signed Act PDF
    03/04/2020 Final Act PDF
    02/27/2020 Rerevised PDF
    02/21/2020 Revised PDF
    02/04/2020 Reengrossed PDF
    02/03/2020 Engrossed PDF
    01/08/2020 Introduced PDF

The effective date for bills enacted without a safety clause is August 7, 2024, if the General Assembly adjourns sine die on May 8, 2024, unless otherwise specified. Details