SB 135

Bill Subjects

Arbitration Emergency Medical Services Health, Health Care Costs; Health Insurance Health, Health Maintenance Organizations Insurance, State Department And Agencies

Abstract

Provides that: (1) when an individual covered by a health plan is provided emergency ambulance service by a nonparticipating ambulance service provider, the health plan operator shall pay toward the compensation of the nonparticipating ambulance service provider the amount that the health plan operator considers reasonable compensation for the emergency ambulance service; and (2) after the health plan operator pays this amount and after any deductible, copayment, and coinsurance amount is paid, neither the nonparticipating ambulance service provider nor the health plan operator may seek to obtain any further amount from the covered individual. Provides that if the nonparticipating ambulance service provider considers the amount paid to be insufficient, the nonparticipating ambulance service provider: (1) may initiate negotiations with the health plan operator; and (2) if negotiations do not produce a result satisfactory to the nonparticipating ambulance service provider, may initiate arbitration of the ambulance fee dispute. Provides for the selection of an arbitrator and establishes a procedure by which the arbitrator determines a figure representing fair compensation for the emergency ambulance service. Provides that an arbitrator's determination as to fair compensation is binding on the parties and is admissible in any court proceeding. Empowers the insurance commissioner to reprimand, impose a civil penalty on, or suspend the certificate of authority of a health plan operator that fails upon request to provide information on compensation paid to participating ambulance service providers, refuses to negotiate in good faith, or refuses to compensate a nonparticipating ambulance service provider in accordance with an arbitrator's determination. Requires the Indiana emergency medical services commission to adopt rules concerning the certification of arbitrators and the administration of the ambulance fee dispute resolution process.