AN ACT TO ENCOURAGE HEALTH INSURANCE CONSUMERS TO COMPARISON SHOP FOR HEALTH CARE PROCEDURES AND TREATMENT: would require health care entities to disclose the allowed amount/amount to be charged at least two working days prior to a patient’s receipt of admission, a procedure, or a service if a patient requests it. If the health care entity cannot predict, with certainty, the charges, it must do so to the best of its ability. Should a health care entity fail to disclose the required information, it would be prohibited from billing the patient or the patient’s insurance carrier for the admission, procedure, or service. If the health care entity participates in the patient’s carrier network, the entity would be required to provide sufficient information about the cost of the admission, procedure, or service via a publicly accessible website and a toll-free phone number.
LD1305 would also require that health care entities and insurance carriers have access—at no cost—to the Main Health Data Processing Center’s all-payor and all-settings health care database for the purpose of providing cost information to its patients and prospective patients. Disclosed information would be reasonably limited to the minimum extent necessary and could only be used for the purposes of providing patients with information about prospective admissions, procedures, and services.
LD1305 would also require health carriers to a establish toll-free phone numbers and publicly accessible websites that would enable their enrollees to request and obtain information regarding the average price paid in the last 12 months to network providers for proposed admissions, procedures, and services—by geographic rating area. Health carriers would be required to provide an enrollee with a binding estimate for the maximum allowed charge within 2 business days of a request.
Additionally, if an enrollee were to elect to receive health care services from a provider that cost less than the average amount for a particular admission, procedure or service, a carrier would be required to pay to an enrollee 50% of the saved cost to a maximum of $7,500 except that a carrier is not required to make a payment if the saved cost is $50 or less. A payment to an enrollee would need to be made within 30 days. If an enrollee were to elect to receive health care services from an out-of-network provider that cost less than the average amount for a particular admission, procedure or service, a carrier would be required to apply the enrollee’s share of the cost of those health care services as specified in the enrollee’s health plan toward the enrollee’s member cost sharing as if the health care services were provided by a network provider.
LD1305 would also require all carriers to file with superintendent of insurance, on an annual basis: the total number of patient requests for binding estimates, the total number of cost-savings transactions made, the average cost of these transactions, the total savings achieved below the average cost by services for such transactions, the total number of payments made to enrollees, and the total number and percentage of a carrier’s enrollees that participated in such transactions.