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2019 SESSION

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HB 1714 Balance billing; emergency services.

Introduced by: R. Lee Ware | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Balance billing; emergency services. Directs health carriers that provide individual or group health insurance that provide any benefits with respect to services rendered in an emergency department of a hospital to pay directly to an out-of-network health care provider the fair market value for the emergency services, less applicable cost-sharing requirements. The bill provides that direct payment from the health carrier to the out-of-network health care provider precludes the out-of-network health care provider from billing or seeking payment from the covered person for any other amount other than the applicable cost-sharing requirements. The measure defines fair market value as that price that is determined by considering the amounts billed to and accepted from health carriers or managed care plans by similar providers for comparable out-of-network emergency services in the community where the services were rendered, with the exclusion of amounts accepted by providers for patients covered by Medicare or Medicaid. The bill removes from the determination of whether a medical condition is an emergency medical condition the final diagnosis rendered to the covered person.


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