Bill > H1126

This bill streamlines patient disclosure requirements for healthcare providers regarding billing estimates and insurance participation. Under the new law, when a non-emergency medical procedure is scheduled, healthcare providers must disclose whether they participate in the patient's health insurance plan. If the provider is in-network, they must provide the insurance carrier with a good faith estimate of expected billing and diagnostic codes, and the carrier must then inform the patient of their estimated out-of-pocket costs within 3 business days (if scheduled 10+ days in advance) or 1 business day (if scheduled with less notice). For out-of-network providers or uninsured patients, providers must furnish a detailed cost estimate, including potential facility fees, and inform patients about potentially lower-cost alternative providers. If a provider fails to provide these required notifications, they can only bill the patient for standard copayments, coinsurance, or deductibles. The bill also establishes enforcement mechanisms, with the commissioner authorized to impose penalties up to $2,500 per instance for non-compliance by healthcare providers or insurance carriers, with provisions to avoid duplicate penalties from federal agencies.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/H1126