Bill > S680

This bill aims to protect consumers from surprise out-of-network medical bills. Key provisions include: 1) Defining important terms like "emergency services", "in-network contracted rate", and "out-of-network provider/facility" to clarify the scope of the bill. 2) Requiring carriers to cover emergency services without prior authorization and limit cost-sharing to in-network amounts, even if the provider is out-of-network. 3) Establishing an independent dispute resolution process for out-of-network bills, where the carrier and provider can negotiate a payment amount. The process has specific guidelines and factors to consider. 4) Prohibiting out-of-network providers from billing patients more than the in-network cost-sharing amount in certain situations, unless proper notice and consent is provided. 5) Requiring carriers to maintain provider networks that are adequate to ensure timely access to covered services, with specific standards for geographic accessibility, appointment wait times, and network composition. Overall, the bill aims to protect consumers from surprise out-of-network medical bills and improve network adequacy requirements for health plans.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/192/S680