SB 415 – Greater Transparency in Health Care Billing

SB 415 – Greater Transparency in Health Care Billing

Primary Senate Sponsors: Sen. Ralph Hise (R-Madison, McDowell, Mitchell, Polk, Rutherford, Yancey); Sen. Joyce Krawiec (R-Davie, Forsyth); Sen. Jim Burgin (R-Harnett, Johnston, Lee)

Summary

This bill:

  • Sets out a series of defined terms.
  • Amends current statutory language regarding services by outside provider networks by requiring the insurer, following notice from the insured, to determine whether a health care provider able to meet the needs of the insured as reasonably available to the insured without unreasonable delay based upon the insured’s location and specific medical needs.
  • Requires the amount allowed for services provided under the amended language to be calculated using a statutory benchmark amount, unless otherwise agreed to by the health care provider and the insurer.
  • Prohibits healthcare providers from requiring an insured to pay an amount in excess of the applicable payment under statute prior to services being rendered to the insured.
  • Establishes a statutory benchmark amount presumed to be a reasonable total payment for services provided by a health care provider outside an insurer’s health care provider network or for emergency care services.
  • Prohibits health service facilities and healthcare providers from collecting an amount for services and excess of the statutory benchmark unless the insurer does not have contracted health care providers or health services facilities in its health care provider network that are able to meet the needs of the insured and that are reasonably available to the insured without unreasonable delay.
  • Requires health services facilities contracting with providers that do not participate in an insurer’s health care provider network to require the non-participating health care providers to comply with the billing and collections practices established by statute.
  • Requires health care providers that do not participate in the insurer’s health care provider network to include a statement on any billing notice to an insured that the insured is not responsible for paying any more than the applicable in network deductible, co-payment, or co-insurance amounts and has no legal obligation to pay any remaining balance in excess of the statutory benchmark amount.

Movement

Filed – 3/30/2021

 
 

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