Bill > S522

This bill aims to reduce the financial burden of surprise medical bills for patients. It does so by: 1) Requiring insurance carriers to pay non-participating providers a reasonable amount, not less than the Medicare reimbursement rate, for emergency services rendered to an insured individual. The insured is prohibited from paying more out-of-pocket than they would have with a participating provider. 2) Requiring insurance carriers to pay non-participating providers at participating facilities a reasonable rate, not less than the Medicare reimbursement rate, for services the carrier is required to cover. Again, the insured is prohibited from paying more out-of-pocket than they would have with a participating provider. 3) Prohibiting non-participating providers from billing or seeking payment from the insured, except for applicable copays, coinsurance, or deductibles, if the provider does not comply with the eligibility check and written consent requirements outlined in the bill. The key terms are "non-participating provider" (a provider without a contract with the insurance carrier) and "non-participating provider rate" (defined as 100% of the Medicare reimbursement rate or reasonable approximation thereof).

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https://malegislature.gov/Bills/190/S522