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Out-of-network Health Care Services

Concerning out-of-network health care services provided to covered persons, and, in connection therewith, making an appropriation.
2019 Regular Session
Bill Summary

The bill:

  • 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;
  • Creates a penalty for failure to comply with the payment requirements for out-of-network health care services; and
  • Appropriates money from the general fund to the department of public health and environment and from the division of insurance cash fund to the division of insurance.
    (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)


Became Law


Bill Text