Bill > H1197

This bill aims to address out-of-network billing in health insurance. Key provisions include: 1. Defining key terms such as "emergency services," "in-network contracted rate," "network facility," and "out-of-network provider." 2. Requiring carriers to cover emergency services without prior authorization, at in-network cost-sharing rates, and pay the provider an amount equal to the "qualifying payment amount" (which is generally based on the median in-network rate for that service in that region). 3. Establishing an "independent dispute resolution" (IDR) process for resolving payment disputes between out-of-network providers and carriers, with specific criteria for the IDR entity to consider. 4. Prohibiting out-of-network providers from billing patients more than the in-network cost-sharing amount for certain services provided at in-network facilities, unless the provider follows notice and consent procedures. 5. Requiring carriers to maintain adequate provider networks, with standards set by the state Commissioner for factors like geographic accessibility and wait times. Overall, the bill aims to protect patients from surprise out-of-network medical bills and ensure fair payment rates between providers and insurers.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/192/H1197