SB 416 Summary

• Requires health facilities to provide written notice to patients before nonemergency admission or initial treatment disclosing that nonparticipating providers at the facility may bill patients for amounts unpaid by their health plan.

• Defines "balance bill" as a noncontracted provider's charge to an insured for the difference between their fee and the sum of insurer payments plus the insured's cost-sharing amounts.

• Requires insurers using provider networks to provide written notice to insureds that facility-based providers may not be contracted providers and that noncontracted providers may charge balance bills; notice must be included in policy materials, benefit documents, and prominently displayed on policy websites.

• Requires insurers to include the Department of Insurance consumer protection division telephone number on explanations of benefits containing remark codes indicating payments made to noncontracted providers.

• Establishes violations of these requirements as grounds for disciplinary action against facilities and as unfair and deceptive acts in insurance for insurers and health maintenance organizations; applies to health maintenance organizations under parallel provisions.

• Effective date: July 1, 2011.