CO SB206

Carriers must pay out-of-network providers directly for covered nonemergency services provided at in-network facilities at the lesser of the provider's billed charge or the eightieth percentile of current charges in the same geographic area, minus applicable in-network cost-sharing amounts.

In-network facilities, carriers, and out-of-network providers must provide written disclosures to covered persons explaining that out-of-network providers may be involved in treatment, that services are covered at in-network benefit levels, and that the patient is responsible only for in-network cost-sharing amounts.

Creates an independent dispute resolution process (IDRP) allowing out-of-network providers to challenge carrier payment determinations after exhausting internal review, with decisions made within thirty business days and binding on both parties.

Carriers that routinely fail to reimburse out-of-network providers as required forfeit the right to discount billed charges and must pay full billed amounts, and violations constitute unfair or deceptive insurance practices.

Emergency department services must be covered with the same cost-sharing requirements as in-network emergency services and at no greater cost to the covered person.