CO SB152

In-network facilities must provide written disclosures to covered persons listing types of out-of-network providers they may encounter and stating in plain language that facility-based providers may not be contracted with the patient's carrier, potentially resulting in higher costs.

Out-of-network facility-based providers must include plain language statements on billing notices informing covered persons they are not participating with the plan and that patients regulated by the Division of Insurance may only be responsible for applicable in-network cost-sharing amounts.

Carriers must provide written notice in plain language at the time of preauthorization for in-network facility services, informing covered persons they might be treated by out-of-network providers and that they can request assistance identifying participating providers.

Carriers must submit information to the insurance commissioner regarding use of out-of-network providers by covered persons, including provider specialty and whether charges were paid in full or at a negotiated price.

The bill takes effect January 1, 2017, and the carrier reporting requirements expire and are repealed effective February 2, 2021.