“Health Care Consumer’s Out-of-Network Protection, Transparency, Cost Containment and Accountability Act.” This bill is intended to provide remedies for individuals who are treated by physicians and treated in facilities that do not belong to a provider network used by the individual’s health benefits plan and who are consequently billed for the balance of charges that are not paid for by their health benefits plan.

In order to provide such services and to provide transparency in the health care system, the bill requires that at the time a non-emergency medical procedure or other health care service is scheduled for a covered person, a physician must disclose to the patient whether or not he is a participating physician in the health benefits plan in which the covered person is a member. In the event that a patient or insurer or third party administrator receives a balance bill from a physician or facility, the bill provides two peer review mechanisms – one for physicians and one for health care facilities.