This legislation would lessen the impact of surprise medical billing. Surprise billing occurs when a patient receives care from a physician who does not contract with their health insurer and is considered an out-of-network provider. The situation can leave patients with large medical bills when they receive care, often unknowingly, from a provider who is not part of their health insurer’s established network.
The legislation would require care providers to inform patients in advance of a scheduled procedure that their health insurer may not cover all of their medical services and that they can request care from an in-network provider. The notice must inform the patient that a non-participating provider must provide them “a good-faith estimate of the cost of the health care services to be provided.” However, in emergency situations, the out-of-network provider would have to accept payment at the median amount within the region that a health insurer pays an in-network provider, or accept 150 percent of what Medicare pays for a medical service, whichever is greater.
Patients would still have to pay their customary copays or deductibles built into the health insurance coverage.