Bill > SB165

This bill amends Ohio law to enhance protections for patients seeking emergency medical services by prohibiting health insurance corporations and sickness and accident insurers from unfairly denying or reducing insurance claims. The bill expands the definition of "emergency medical condition" to explicitly include mental health conditions and prevents insurers from denying claims based solely on diagnosis codes, procedure codes, or the duration of medical appointments. It requires insurers to cover emergency services without prior authorization, regardless of the time of day or whether the patient is at a participating or non-participating hospital. The bill also mandates that insurers inform enrollees about their emergency service coverage, including that patients are not required to self-diagnose their medical conditions. Additionally, the legislation introduces provisions to ensure that if a reasonable layperson would have expected an emergency medical condition to be present, the insurer cannot deny the claim. These changes aim to protect patients from potential gaps in emergency medical coverage and ensure more comprehensive and fair health insurance practices, with specific protections for individuals seeking urgent medical care.

Business and Industry

https://www.legislature.ohio.gov/legislation/136/sb165