OH SB198

Prohibits individual out-of-network providers from billing patients for the difference between insurance reimbursement and their charges for unanticipated out-of-network care at in-network facilities or emergency services.

Requires health plan issuers to reimburse out-of-network providers the lesser of the provider's charge or the eightieth percentile of charges for similar services in the same geographic area, using a benchmarking database specified by the superintendent of insurance.

Establishes binding arbitration process for reimbursement disputes exceeding $700 or involving two or more disputed claims totaling over $700, with the non-prevailing party paying arbitrator fees.

Requires health plan issuers to provide comprehensive online and print directories of in-network providers and facilities with searchable formats, updated monthly, including provider credentials, specialties, and facility information.

Applies to individual providers and health benefit plans delivered, issued, modified, or renewed on or after April 1, 2020, but excludes Medicaid managed care plans and services subject to fee schedules under workers' compensation laws.