HB 2544

Bill Subjects

Abstract

Establishes that an individual shall not be required to pay to an out-of-network provider for emergency services any amount in excess of the amount the health carrier is required to pay for covered services except applicable deductibles, copayment, coinsurance, or other cost-sharing amounts deemed by the health carrier to be non-covered services. The measure also replaces one of the three tests for determining the benefit the carrier is required to provide to an out-of-network provider of emergency services. The new test is the average of the contracted commercial rates paid by the health carrier for the same emergency service in the geographic region, which test replaces the amount negotiated with in-network providers for the emergency service, or if more than one amount is negotiated, the median of these amounts. The measure also authorizes an out-of-network provider to request the Bureau of Insurance to determine whether the benefits that the health carrier has determined to satisfy its obligation to provide benefits for emergency services provided satisfy that obligation.