Bill > H932

This bill aims to address the issue of out-of-network healthcare billing. The key provisions are: 1. If an insured receives unavoidable out-of-network services, the insurance carrier must pay the out-of-network provider directly, and the insured's cost-sharing is limited to the amount they would have paid for in-network services. 2. Insurers must pay out-of-network providers at least the minimum benefit standard, which is the greater of the in-network rate, the usual and customary rate, or the Medicare reimbursement rate. 3. Out-of-network providers are prohibited from balance billing the insured, except for "opt-out" services where the insured voluntarily chooses an out-of-network provider. 4. The bill establishes a mediation process for disputes between providers and insurers over out-of-network reimbursement. 5. Insurers are prohibited from providing false or misleading information to insureds about out-of-network billing and the mediation process. 6. The bill includes enforcement mechanisms, such as prohibiting providers from repeatedly balance billing insureds and allowing the state insurance division to penalize non-compliant insurers. 7. The bill requires transparency measures, such as disclosing network status and cost estimates to insureds when scheduling services. This bill aims to protect insured patients from surprise out-of-network medical bills and ensure fair reimbursement for out-of-network services.

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https://malegislature.gov/Bills/191/H932