S.B. 2423 Summary

• Non-participating providers cannot bill enrollees more than the copayment, coinsurance, or deductible amounts they would pay for in-network emergency services.

• Managed care plans must negotiate with non-participating providers on payment amounts within 45 days, or either party may pursue independent binding arbitration.

• The Insurance Commissioner refers unresolved disputes between insurers and non-participating providers to an independent dispute resolution entity for binding arbitration.

• Arbitrators must consider factors including fee disparities, provider qualifications, usual billed charges, case complexity, and patient characteristics when determining appropriate payment amounts.

• Dispute resolution costs are borne by the non-participating provider if the plan's payment is deemed reasonable, by the plan if the provider's fee is reasonable, or split equally if parties reach a settlement.

• Effective January 1, 2021.