Bill > S526

This bill aims to address the issue of out-of-network services provided by emergency medicine clinicians. The key provisions are: 1. It defines key terms such as "emergency department visit", "emergency medicine clinician", and "out-of-network services". 2. It establishes a "minimum emergency medicine services benefit" that insurance carriers must pay to out-of-network emergency medicine clinicians, which is the greater of the usual and customary rate or the amount Medicare would reimburse, up to a cap of $1,500 per visit (adjusted for inflation). 3. It requires insurance carriers to pay the minimum emergency services benefit directly to the out-of-network emergency medicine clinician within 30 days of the claim submission. 4. It prohibits emergency medicine clinicians from billing the insured separately or holding the insured financially responsible for out-of-network services. 5. It prohibits insurance carriers from providing false or misleading information in the written explanation of benefits to the insured. 6. It allows a person aggrieved by a violation of the bill's provisions to file a civil action in the Commonwealth.

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https://malegislature.gov/Bills/190/S526