New state law targets surprise medical bills
"When a patient receives care from an out-of-network provider, the insurer may pay nothing, the full list price (or charge amount), or some amount in between," the
In "A Pandemic
The insured patient receives care from an out-of-network provider in an emergency situation where the patient has no capacity to select the care.
The insured patient receives pre-planned care from an in-network facility, but the services are provided by an out-of-network provider.
A federal law effective
Patients may be admitted to the emergency room of a hospital that partakes in their insurance plan, but when they are there, the patient sometimes receives medical services from an emergency-room doctor who does not participate. That doctor, under the new federal law, cannot bill the patient for their healthcare services.
The new state law addresses balance-billing in non-emergency scenarios. The state law complements the federal one, but it merely stipulates that a healthcare provider divulge whether they partake in their patient's insurance plan a week before carrying out a non-emergency procedure.
According to Mathur, the state law also mandates the following:
Providers to disclose if they are out-of-network prior to the patient's admission.
Providers, upon request, to share the amount that the patient will be charged for admission, a procedure, or a service, including costs for services done by an out-of-network provide.
Providers to notify patients if the patient is being referred to an out-of-network provider
Prohibits providers from billing insured patients in excess of the typical, applicable coinsurance, co-payment, or deductible that would have been charged if services were provided by an in-network provider
Noncompliance with the state law comes with a
"To date, at the state level, 27 states have passed consumer protection laws against surprise medical bills," Mathur writes. "In 2020, five additional states have passed and will enact or have enacted surprise billing legislation."
WHEN: The law goes into effect on
WHERE: The commonwealth of
WHO: Healthcare providers, facilities, insurance companies, patients
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