Bill > H1156

This bill introduces new regulations for healthcare carriers and providers regarding uncollected patient financial obligations, specifically co-payments, co-insurance, and deductibles. Under the proposed law, healthcare carriers would be required to reimburse providers at least 65% of unpaid patient financial responsibilities after the provider has made reasonable collection efforts. To qualify for reimbursement, the uncollected amount must be at least $250, related to a unique covered service, and the provider must document collection attempts over at least 120 days. Providers must submit an annual aggregate reimbursement request by May 1st, including details like patient identification, service date, and collection attempt documentation. The bill defines key terms such as 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). Carriers retain the right to audit these reimbursement requests and must resolve any disputes within 120 days. Additionally, the bill requires the division to develop regulations consistent with Centers for Medicare & Medicaid Services guidelines and to publish an annual public report detailing reimbursed and denied uncollected patient financial obligations, ultimately aiming to help healthcare providers recover more of their unpaid costs while protecting patients.

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https://malegislature.gov/Bills/194/H1156