Out-of-Network Health Insurance Dispute Resolution

The bill makes changes to the dispute resolution process between health insurance carriers (carriers) and out-of-network health-care providers (providers) by:

• Mandating that a carrier provide a remittance advice with each payment made to a provider;
• Establishing penalties that the division of insurance (division) may assess against a carrier that fails to properly reimburse a provider for services provided to a patient;
• Requiring a carrier to annually submit information to the division concerning patient use of out-of-network providers; and
• Requiring the division to produce an annual report regarding patient use of out-of-network providers and relevant arbitration data and statistics.
  (Note: This summary applies to this bill as introduced.)