S 415 – North Carolina

Status: Inactive / Dead
Year Introduced: 2021
Link: https://www.ncleg.gov/BillLookUp/2021/S415

Greater Transparency in Health Care Billing: Amends GS 58-3-200(d) regarding services by outside provider networks. Now requires the insurer, upon notice from the insured, to determine whether a health care provider able to meet the needs of the insured is reasonably available to the insured without unreasonable delay by reference to the insured’s location and the specific medical needs of the insured. Requires the amount allowed for services provided under subsection (d) to be calculated using the benchmark amount under GS 58-3-201, as enacted, unless otherwise agreed to by the health care provider and the insurer. Does not require an insurer to make any direct payment to a health care provider. Prohibits health care providers from subjecting an insured to or otherwise requiring prior payment of an amount in excess of the applicable reasonable payment under GS 58-3-201, as enacted, prior to services being rendered to the insured. Enacts GS 58-3-201, setting a benchmark amount, to be calculated at least annually, which is presumed to be a reasonable total payment for services provided by a health care provider outside an insurer’s health care provider network, or for emergency care services provided. Details the calculation of the benchmark amount, and provides for the application of the benchmark amount, deeming payment of the amount to foreclose the health care provider from collecting additional amounts from the insured or any third party. Specifies that the insurer is not required to make payment of any amount owed directly to a health care provider. Deems noncompliance an unfair and deceptive trade practice and actionable under GS Chapter 75. Specifies that the provisions do not foreclose other remedies available.

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