SB 1057 - This act specifies that health care professionals shall send any bill for charges incurred for unanticipated out-of-network care to the patient's health carrier, and the carrier shall pay the professional directly. The act specifies how the payments are to be calculated, including with regard to cost-sharing requirements such as copayments, coinsurance, deductibles, and out-of-pocket maximums.
The Director of the Department of Insurance, Financial Institutions, and Professional Registration shall ensure access to a mediation process when a health care professional objects to the payments described in the act. The Department shall determine usual and customary rates for payments for health care services based on benchmarks from independent nonprofit organizations that are not affiliated with insurance carriers or provider organizations. The act specifies that health care professionals may initiate mediation if they believe the payment received for unanticipated out-of-network care does not properly account for certain factors. Health care professionals may combine similar claims and claims presenting a common issue of fact to be resolved in a single mediation process.
This act is similar to provisions in SS/SB 982 (2018), and to SCS/SB 928 (2018), and to provisions in HCS/SB 575 (2018).
ERIC VANDER WEERD