Bill > S758

This bill requires health insurance carriers to reimburse healthcare providers at least 65% of unpaid patient co-payments, co-insurance, and deductibles under certain conditions. Specifically, providers can request reimbursement for individual claims of $250 or more that remain uncollected after 120 days of reasonable collection efforts, which must include documented attempts like phone calls and collection letters. To qualify for reimbursement, providers must submit an annual aggregate request by May 1st, including detailed documentation about each unpaid claim such as the patient's identification, service date, and collection attempts. The insurance carrier can audit these requests within 120 days and must pay the undisputed amounts. Importantly, the bill defines key terms like co-payment (a fixed dollar amount), co-insurance (a percentage of the allowed amount), and deductible (a specific dollar amount paid before insurance coverage begins). The legislation aims to share financial responsibility between healthcare providers and insurance carriers for patient obligations that cannot be collected, while also ensuring that providers can still attempt to collect the full amount owed by patients at the time of service.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S758