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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

Statutory Revision Committee. House Bill 19-1174, enacted January 1, 2020, requires a health insurance carrier to reimburse an out-of-network health care provider who provides emergency services or covered nonemergency services to a covered person at an in-network facility 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 claims database.

The bill corrects a conforming amendment that was made in House Bill 19-1174 that inaccurately stated the reimbursement rate.

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


Under Consideration


Bill Text

Upcoming Schedule