OH HB99

Amends sections 1753.28 and 3923.65 of the Revised Code to regulate health insuring corporations and sickness and accident insurers regarding emergency services reimbursement denials and reductions.

Prohibits insurers from reducing or denying emergency services claims based solely on diagnosis codes, ICD codes, or procedure codes, or based on absence of an emergency medical condition if a prudent layperson would reasonably have expected an emergency to exist.

Requires emergency services utilization reviews be conducted by board-certified emergency medicine physicians with recent acute care emergency department experience who are not otherwise employed by the insurer.

Mandates utilization reviewers examine the entire medical record including presenting symptoms, medical history, diagnostic testing, and whether a prudent layperson would reasonably presume an emergency medical condition existed.

Requires written explanations from reviewers including name, date, signature, and supporting evidence when reducing or denying emergency services claims, provided to both enrollee and provider.