Bill > S1442

This bill aims to improve transparency and patient protections regarding out-of-network healthcare costs by requiring hospitals, ambulatory surgical centers, specialty hospitals, and urgent care centers to comply with new provisions as a condition of their licensure. Specifically, hospitals must now post on their websites a list of health insurers and health maintenance organizations (HMOs) they contract with, along with a disclosure statement informing patients that services may be provided by other healthcare practitioners who may bill separately and may not be in the same insurance networks as the hospital. The bill also establishes a statewide provider and health plan claim dispute resolution program, outlining procedures for settlement offers and evidentiary hearings, and clarifies that willful failure to comply with these new coverage requirements can lead to disciplinary action against healthcare providers and facilities. A new section, 627.64194, defines terms like "emergency services," "facility," and "nonparticipating provider" (a provider not contracted with an insurer) and establishes that insurers are solely liable for payment of covered emergency and certain nonemergency services provided by nonparticipating providers, with patients only responsible for copayments, coinsurance, and deductibles. This section also mandates that insurers reimburse nonparticipating providers at a rate specified in section 641.513(5) and limits the amount nonparticipating providers can collect from patients. Furthermore, insurers must now list their preferred providers on their websites, updated monthly, and policies issued after January 1, 2017, must include a warning to policyholders about limited benefits when using nonparticipating providers and the potential for higher out-of-pocket costs.