HB 603 Summary

• Defines "facility-based physicians" as radiologists, anesthesiologists, pathologists, emergency department physicians, neonatologists, or assistant surgeons providing services at a facility under clinical privileges.

• Requires facility-based physicians billing out-of-network patients to include conspicuous notice of mandatory mediation process on billing statements when patient responsibility exceeds $250 after copayments, deductibles, and coinsurance.

• Allows enrollees to request mediation for out-of-network facility-based physician claims exceeding $250 when services are provided at hospitals that are preferred providers or have contracts with the health plan administrator.

• Amends Section 25-15-17 to permit direct payment of health benefits to licensed health care providers when the covered employee provides written direction, with payment considered in full except for deductibles, coinsurance, copayments, and noncovered services.

• Effective date: July 1, 2017 for medical services provided on or after that date.