The out-of-network reform bill introduced Thursday covers more than just emergency room out-of-network care; it also covers “inadvertent” out-of-network care, such as when a patient goes to an in-network hospital for a nonemergency procedure and gets care from an out-of-network provider (anesthesiologist, radiologist, pathologist, etc.) who works…A look at the key components of the bill:
- Health care facilities would be prohibited from billing the patient for urgent or emergency out-of-network care in excess of any of the deductibles, copayments or coinsurance amounts that they would normally charge for in-network care.
- Health care facilities would be restricted from billing the out-of-network patient’s insurance carrier in excess of the maximum payment (to be set by the health price index) for a given urgent or emergency service.
- At least every 20 days, insurance carriers must publish an updated list of all in-network providers.
- Health care facilities must offer patients a written disclosure form at least 30 days prior to a medical procedure that states whether or not the service will be in-network or out-of-network and gives a reasonable estimate for all associated costs with the service, which must also be thoroughly explained.
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