HB 2504 Summary

• Requires nonparticipating health care providers to disclose in writing that they are out-of-network and may charge substantially higher rates, with 24-hour advance notice and written consent required before providing non-emergency services.

• Prohibits nonparticipating providers from billing patients more than the in-network cost-sharing amount (copayment, coinsurance, or deductible) when patients receive emergency services or when providers fail to obtain proper disclosure and consent.

• Requires health insurers, mutual benefit societies, and health maintenance organizations to negotiate with nonparticipating providers for emergency services and enter into independent dispute resolution if no agreement is reached.

• Establishes an independent dispute resolution process for determining reasonable reimbursement rates for nonparticipating providers, with mediators considering factors including geographic benchmarking data, provider qualifications, and comparative in-network rates.

• Amends insurance disclosure requirements to include examples of anticipated out-of-pocket costs for out-of-network services and online tools for estimating anticipated costs; effective July 1, 2050.