OH HB270

Requires health insurers and sickness/accident insurers to obtain an independent emergency physician review before denying benefits, reducing reimbursement, or downgrading emergency service claims based on final diagnosis or medical necessity determinations.

Mandates that independent reviewers be board-certified emergency physicians with recent acute care experience and prohibits their direct or indirect employment by the insurer except for utilization review purposes.

Prohibits reducing or denying claims based solely on final diagnosis, ICD code, or procedure codes; requires comprehensive medical record review including patient history, diagnostic testing, and physician decision-making.

Requires insurers to educate enrollees/policyholders that emergency care is covered even if subsequent evaluation determines no emergency existed, and that enrollees are not required to self-diagnose.

Classifies repeated violations as unfair and deceptive insurance practices and applies prompt payment requirements to emergency service claims.