SB2165 Summary

• Bill becomes effective only if House Bill 5085 of the 96th General Assembly becomes law, creating conditional amendments to multiple insurance-related statutes.

• Allows nonparticipating facility-based physicians and providers (in radiology, anesthesiology, pathology, neonatology, and emergency services) to bill patients for noncovered services as determined by the insurer or health plan, but prohibits balance billing for covered services.

• When in-network services are unavailable at participating hospitals or surgical centers, patients incur no greater out-of-pocket costs with nonparticipating facility-based providers than they would with in-network providers.

• Establishes binding arbitration process for reimbursement disputes between insurers and nonparticipating facility-based providers, with decisions required within 45 days of filing with the Department of Insurance.

• Requires the Department of Insurance to monitor implementation and report findings to the General Assembly by July 1, 2012, and applies these protections to state employees, counties, municipalities, schools, HMOs, and voluntary health services plans.