IA SF2455

Requires health benefit plans to cover emergency services and other health care services provided by out-of-network providers when the patient receives care at a participating facility but lacks the ability to choose an in-network provider.

Mandates health carriers reimburse out-of-network providers within 60 calendar days at the greater of two amounts: the median rate paid to in-network providers in the same specialty, or 150% of the most recent Medicare reimbursement rate.

Establishes a binding arbitration process for payment disputes between health carriers and out-of-network providers, with arbitrators selected from American Arbitration Association or American Health Law Association rosters maintained by the Insurance Commissioner.

Defines "complicating factors" as elements not typically involved in standard care (such as condition severity or special effort required) that are not reflected in procedure codes and may warrant additional reimbursement consideration.

Prohibits balance billing of covered persons for out-of-network emergency services, limiting patient cost-sharing to amounts that would apply if an in-network provider had delivered the care.