SB 386 – Greater Transparency in Health Care Billing

SB 386 – Greater Transparency in Health Care Billing

Primary Sponsors: Sen. Ralph Hise (R-Madison), Sen. Joyce Krawiec (R-Forsyth)

Bill Summary

This bill states that upon notice from the insured, the insurer shall determine whether a health provider is able to meet the needs of the insured an is reasonably available to the insured without unreasonable delay due to location and medical needs.

The bill states that unless the provider and the insurer agree the amount allowed for services shall be calculated using the benchmark listed in the next section of the bill. Insurers would not be required to make a direct payment to a health provider. The bill states that prior to services being rendered to the patient, no provider an require a prior payment in the amount of or in excess to what is listed in the next section of the bill.

Limitation on Balance Billing

The benchmark calculation would be based on whatever is the least of the following options:

  • 100% Medicare
  • Provider’s actual charges
  • Median contracted rate in the insurer’s health care provider network for the same /similar service

The bill states that any provider’s repeated failure to comply shall indicate a general business practice that is unfair and deceptive trade practice and shall be actionable under Chapter 75 of the General Statutes.

Fair Notice Requirements

The bill outlines the following disclosure statements from a health care facility or provider:

  • Other providers who may separately bill
  • Certain providers that may be called upon that may not have contracts with the patient’s insurer
  • Insurer and Insured have no legal obligation to pay more than the benchmark amount
  • Receipt by the provider for payment of services to insured by the insurer
  • Consumer protections available

The bill contains separate provision on emergency services provided at nonparticipating health service facilities or providers.

Billing and Collection

The bill states that a facility or provider shall not collect an amount greater than the benchmark if they are out of network.

Out of Network Providers

The bill states that out of network providers shall include a statement on any billing notice sent to an insured individual that the insured is not responsible for paying more than the applicable in network, copayment, or insurance amount.

Bill Movement

This bill was filed on March 27, 2019.

This bill was referred to the Senate Rules Committee on March 28, 2019.

 

 
 

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