SB 26-17

Senate Bill 26-17, which has been signed into law, aims to improve how health insurance companies handle disputes with out-of-network healthcare providers. The bill requires insurance companies to provide detailed payment information to these providers and imposes penalties for failing to properly reimburse them. It also mandates that insurance companies report annually on patients' use of out-of-network services. This will help ensure fairer treatment for both providers and patients when dealing with out-of-network claims, making it easier to understand and resolve billing issues.

Official Summary

The bill makes changes to the dispute resolution process between health insurance carriers (carriers) and out-of-network health-care providers (providers) by requiring a carrier to provide, with each payment made to a provider, a remittance advice that: Identifies when the associated health benefit plan is regulated by the state and when the payment is made pursuant to services received from an out-of-network provider or at an out-of-network facility; andProvides the carrier's median in-network reimbursement rate for out-of-network claims.      Mandating that a carrier provide a remittance advice with each payment made to a provider;      Establishing penalties that the division of insurance (division) may assess against a carrier that fails to properly reimburse a provider for services provided to a patient;      Requiring a carrier to annually submit information to the division concerning patient use of out-of-network providers; and      Requiring the division to produce an annual report regarding patient use of out-of-network providers and relevant arbitration data and statistics.(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

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