The bill states an out-of-network provider’s total payment for care or for emergency services is reasonable if it is equal to the benchmark amount. An out-of-network provider would be required to send a bill to the insured individual who is responsible for paying in-network cost sharing, but the patient would have no legal obligation to pay the remaining balance when the benchmark applies.
This bill further states that no provider would be able to bill insured individuals for services at a greater rate than the benchmark amount nor would the insurer be required to make any direct payment to the provider.
The benchmark would be calculated as the smallest amount among the following:
- 100 percent of the current Medicare payment rate;
- Health care provider’s charges;
- Median concentrated rate for the same service in a similar area.
Those providers who fail to comply would be deemed engaging in unfair and deceptive trade practice.
We ask that you send this ACTION ALERT to your legislators asking them to oppose this proposal.