Enacting the end surprise medical bills act. SB 357 would enact the End Surprise Medical Bills Act. The bill would prohibit a health
benefit plan, health insurer, or healthcare provider to engage in balance billing practices for services provided in emergency or other situations when the services are provided at a network facility by a
non-network provider or are ordered by an in-network healthcare provider and provided by an out-of-network healthcare provider or laboratory and the covered person relies on the health plan’s
provider directory and the directory was inaccurate. The Insurance Commissioner would enforce the Act and would be required to have rules and regulations established by July 1, 2021. The bill would prohibit a health benefit plan, health insurer, or healthcare provider from issuing a covered person a surprise medical bill. Under SB 357, these groups would pay the median in-network rate under the plan or coverage, less the covered person’s in-network cost-sharing, directly to the healthcare provider. The healthcare provider could accept payment, or the health benefit plan or health insurer would provide information to the healthcare provider about how to initiate
independent dispute resolution. The plan, issuer, or provider could negotiate an amount or initiate independent dispute resolution (IDR).