SB 1064 Summary

• Establishes arbitration procedures for disputed "surprise out-of-network" bills (bills from non-contracted providers at contracted facilities) when the enrollee's cost-sharing responsibility exceeds $1,000 after insurance payment.

• Requires non-contracted health care providers to provide enrollees with written dated disclosure before treatment stating they are not contracted, estimating total charges, and warning that signing waives dispute resolution rights.

• Creates a two-step dispute resolution process: informal settlement teleconference followed by binding arbitration before an impartial arbitrator if no settlement reached, with arbitration decisions issued within 10 business days.

• Limits enrollees' filing deadline to one year from date of service (tolled during health plan appeals), prohibits civil lawsuits once arbitration is requested, and prevents balance billing beyond the arbitrator's award plus the enrollee's cost-sharing requirements.

• Requires health insurers to remit their portion of arbitration awards within 30 days and authorizes the Department of Insurance to establish arbitration procedures through rulemaking; effective December 31, 2018.