Bill Summary: SB 905

• Makes it an unfair trade practice for health care providers or facilities to bill enrollees for emergency services provided by out-of-network providers or facilities, except for coinsurance, copayments, and deductibles.

• Prohibits health carriers from imposing higher out-of-pocket expenses for emergency services from out-of-network providers than would apply if services were rendered by in-network providers.

• Requires health carriers to reimburse out-of-network facility-based providers directly for emergency services at the greatest of three amounts: in-network rates, the plan's standard out-of-network calculation method, or Medicare reimbursement rates.

• Establishes mandatory mediation programs for disputes over emergency service reimbursement when an out-of-network facility-based provider's bill exceeds the carrier's reimbursement by more than $1,000, with mediators selecting either the carrier's calculated amount or the provider's fee.

• Effective January 1, 2020; amends Connecticut General Statutes sections 20-7f and 38a-477aa regarding surprise billing protections and reimbursement procedures.