HB 19-1174 Summary

• Requires insurance carriers to pay out-of-network providers directly when patients receive covered services at in-network facilities, at rates equal to the greater of 110% of the carrier's median in-network rate or the 60th percentile of in-network rates from the all-payer health claims database.

• Mandates carriers cover emergency services at in-network benefit levels regardless of whether the provider or facility is out-of-network, with patients paying only applicable in-network cost-sharing amounts.

• Requires carriers, health care providers, and facilities to provide clear disclosures to patients about out-of-network service risks and payment obligations, with rules to be adopted by January 1, 2020.

• Establishes an arbitration process allowing providers and facilities to dispute payment amounts if they believe reimbursement was insufficient, with decisions made within 45 days.

• Appropriates $33,884 to the Department of Public Health and Environment and $63,924 to the Division of Insurance for implementation, effective January 1, 2020.