This bill creates disclosure, notice, billing, and mediation requirements for the situation in which a patient may receive services from a health care provider that is not in the network of the patient’s defined network plan or preferred provider plan. Under the bill, a defined network plan or a preferred provider plan must annually provide to members of the plan a directory of providers that are in its network. The defined network plan or preferred provider plan must also provide its members a list of health care facilities that are in its network.

The bill also requires that a provider who is not in the network of the enrollee’s defined network plan or preferred provider plan but is providing a service at an in-network health care facility must disclose that information to the enrollee, provide the enrollee a good-faith estimate of the cost of services the enrollee may be responsible for, and inform the enrollee of the availability of mediation to settle disputes over the cost of services.