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2019 SESSION

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HB 2543 Health benefit plans; balance billing for ancillary services.

Introduced by: Kathy J. Byron | all patrons ... notes | add to my profiles

SUMMARY AS INTRODUCED:

Health benefit plans; balance billing for ancillary services. Prohibits an out-of-network provider from balance billing a covered person for the costs of an ancillary service when an in-network provider referred the covered person to the out-of-network provider unless (i) the referring in-network provider provided the covered person with a notice of liability for the balance; (ii) the out-of-network provider, prior to providing an ancillary service to the covered person, provided a good faith estimate of the out-of-network provider's charges upon request; (iii) the out-of-network provider provided the covered person with a notice of liability for the balance; and (iv) the covered person acknowledged, by signing the out-of-network provider's notice of liability for the balance, that he is aware that using the out-of-network provider may result in his being balance billed. The prohibition on balance billing applies to amounts in excess of the allowed amount, which is the amount that a carrier is obligated to pay, pursuant to the terms of the covered person's health benefit plan, to a covered person for ancillary services provided by an out-of-network provider, net any copayment, deductible, or other cost-sharing amount.