Senate Bill 326 Summary

• Requires health insurers to make direct benefit payments to non-contracted providers who have valid assignments of benefits from covered individuals and notify the insurer of services rendered.

• Mandates insurers pay non-contracted providers within 30 days if the insurer initially pays the covered individual instead, upon notification from the provider that payment was not received.

• Requires insurers to provide written notice of payment disputes within 14 business days if there is good faith disagreement regarding claim legitimacy, reimbursement amount, or assignment authorization.

• Requires non-contracted providers to disclose in writing to patients that they are not contracted with the insurer and that patients may be billed for unpaid services, except in emergency situations or when the provider could not reasonably know of coverage.

• Applies the same requirements to health maintenance organizations for payments to non-participating providers, effective July 1, 2010.