Contracts Between Carriers And Providers

The bill:

• Requires a contract between a health insurance carrier (carrier) and a licensed health-care provider (provider) for the provision of health-care services to covered persons under a health coverage plan issued by the carrier (contract) to offer at least one method of payment to the provider for which there is not an associated fee; and
• Prohibits the contract from restricting the form or method of payment the carrier uses to make payments to the provider so that the only acceptable payment method is a credit card payment.

If a carrier initiates a payment to a provider using, or changes the payment method to, electronic funds transfer payments, including virtual credit card payments, the bill requires the carrier to:

• Notify the provider of any fees associated with the particular payment method;
• Advise the provider of the available payment methods and include instructions on how to select an alternative available method; and
• With each payment, remit an explanation of benefits.

The bill prohibits a carrier from charging a fee for a change in the payment method to a specified electronic transaction and allows a provider's billing service to charge a fee under certain circumstances.

The bill makes it an unfair method of competition and unfair or deceptive act or practice in the business of insurance if a carrier violates or fails to comply with the requirements of the contract limitations and requirements. The bill grants enforcement authority to the commissioner of insurance.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)