HI SB792

Requires insurers, mutual benefit societies, and health maintenance organizations to pay health care providers directly regardless of whether the provider participates in their network, provided services are covered under the plan.

Mandates direct payment to providers for emergency services without prior authorization and without regard to network status, with reimbursement equal to usual and customary value for nonparticipating providers.

Establishes that if an insurer, mutual benefit society, or HMO pays the patient instead of the provider, the entity remains liable for payment to the provider.

Requires prompt adjudication of emergency service claims and direct payment to nonparticipating providers, with financial responsibility extending to services provided during inpatient admission to out-of-network hospitals if deemed medically necessary by a licensed physician.

Applies requirements to insurers under Chapter 431, mutual benefit societies under Chapter 432, and health maintenance organizations under Chapter 432D, with exemptions for entities subject to ERISA preemption.