MN SF4209

Excludes emergency services from the definition of "unauthorized provider services," making them subject to different payment rules under Minnesota Statutes section 62Q.55.

Requires enrollees to pay the same cost-sharing amounts (copayments, deductibles, coinsurance) for unauthorized provider services as they would for participating providers, with 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 with nonparticipating providers.

Establishes a binding arbitration process overseen by commissioners of health and commerce to resolve payment disputes between health plans and nonparticipating providers, with arbitration costs split equally between parties.

Requires health plan companies to report annually beginning April 1, 2021, on unauthorized provider service claims, arbitration cases, and enrollee complaints, with enforcement authority granted to commerce and health commissioners and the Minnesota Board of Medical Practice.