MN HF3757

Excludes emergency services from the definition of "unauthorized provider services," clarifying that emergency care from nonparticipating providers is covered under existing emergency service protections.

Requires enrollees pay the same cost-sharing (copayments, deductibles, coinsurance) for unauthorized provider services as they would for participating providers, with these costs applied to annual out-of-pocket limits.

Prohibits providers from billing enrollees more than their financial responsibility and requires health plan companies to attempt negotiating reimbursement rates with nonparticipating providers.

Establishes binding arbitration process for disputes between health plans and nonparticipating providers, with arbitrators considering comparative payment rates, case complexity, and customary industry rates using national databases.

Requires health plan companies to report annually to the commissioner beginning April 1, 2021, including unauthorized provider service claims, billed and paid amounts by service type, and enrollee complaints.