SB3378 Summary

• Health insurers and health plans must pay for out-of-network health care services provided at network hospitals when in-network services are unavailable, the insurer has been contacted in advance, or a network hospital is utilized.

• Patients using out-of-network providers at network hospitals shall not pay more than they would for in-network services, with insurers paying the lesser of actual charges or usual and customary amounts minus applicable patient cost-sharing.

• Out-of-network providers must provide written notice to patients before delivering services, including a good faith estimate of charges, billing policies, and a statement of which insurers and health plans accept their fees as payment in full.

• Providers are prohibited from billing patients for the difference between their charges and insurance payment amounts, except for applicable copayments, deductibles, or coinsurance.

• Network hospitals cannot enter into exclusive arrangements with providers unless those providers agree to contract with insurers or health plans that have contracted with the hospital, or accept the usual and customary amount as payment in full.