SB15-259: Out-of-Network Health Care Provider Charges

• Out-of-network providers rendering covered services at in-network facilities or providing emergency services must submit claims for the entire cost to the insurance carrier and cannot balance bill patients beyond deductibles, copayments, or coinsurance.

• Out-of-network providers seeking payment above the carrier's average in-network rate for the geographic area must submit a demand to the carrier for negotiation rather than billing the patient directly.

• Insurance carriers must provide written notice to covered persons describing their out-of-network obligations, and in-network facilities must inform patients of protections against balance billing prior to treatment.

• Out-of-network providers offering non-emergency services must disclose in writing that they are out-of-network and provide cost estimates upon request; patients must provide written consent before scheduling procedures at out-of-network facilities.

• Providers who waive patient cost-sharing obligations or routinely fail to provide required disclosures engage in deceptive trade practices and forfeit reimbursement rights, with forfeited amounts deemed damages.

• The act takes effect January 1, 2016, subject to voter approval if a referendum petition is filed within 90 days of final legislative adjournment.