BALANCE BILLING UNDER THE MANAGED CARE LAW: This bill prohibits balance billing in the commercial insurance market for certain services provided by out-of-network providers at an in-network facility. The bill further states that fees for such services shall be limited to a commercially reasonable value, based on payments for similar services from NH insurance carriers to NH health care providers. In the event of a dispute between carriers and providers, the bill charges the commissioner of the Insurance Department with determining whether a fee is commercially reasonable. The bill also charges the Insurance Department with granting waivers under certain circumstances, as well as with issuing a report on health insurance premium rates. The Department states that it assumes the bill will have some impact on negotiations between providers and carriers but is unable to determine the extent of this impact on county or local expenditures or how it might affect insurance premium tax collections.

Enacted at N.H. Rev. Stat. Ann. § 420-j.