IA SSB3177

Requires health benefit plans to cover emergency services and other care provided by out-of-network providers when the patient had no ability or opportunity to choose an in-network provider, such as at a participating facility.

Mandates health carriers reimburse out-of-network providers the greater of: the median in-network rate for the same specialty/service, or 150% of the Medicare reimbursement rate, excluding cost sharing.

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 atypical elements in providing care (such as condition severity or special technical/physical/mental effort) that are not reflected in standard procedure codes and may justify additional reimbursement.

Requires out-of-network providers to submit claims within 60 calendar days of service, and health carriers must reimburse within 60 calendar days of receiving the claim.