This bipartisan bill, House Bill 19-1174, which is now headed to the Governor’s desk, prohibits healthcare providers from sending patients a balance-bill when they have unknowingly received out-of-network care. It also sets a reimbursement rate that insurers pay to out-of-network providers.
Specifically, the bill:
-
Requires health insurance carriers, providers, and facilities to provide patients with information regarding the services of out-of-network providers and in-network and out-of-network facilities;
-
Outlines disclosure requirements and the claims and payment process for out-of-network services;
-
Requires several entities such as the insurance commissioner and others to publish requirements for consumer disclosures, including the timing, format, contents, and language;
-
Establishes the carriers’ reimbursement amount for out-of-network providers providing services at in-network facilities and emergency facilities;
-
Creates a penalty for out-of-network providers who fail to comply with the payment requirements; and
-
Reserves money from the general fund to the department of public health and environment, and from the division of insurance cash fund to the division of insurance.
Before this bill, Colorado was among several states that had previously passed different levels of hold harmless protections when it comes to surprise medical billing. Indicated on a map, Colorado has had “partial protections” against balance-billing, which allow the patient to be held harmless from paying a balance-bill for an out-of-network provider at an in-network facility. The problem has been that consumers are largely unaware of this protection. Even worse, nothing stopped the out-of-network provider from sending a bill, or even placing the member in collections or taking a lien out on their mortgage.
This new measure should bump Colorado from the 25-state group with “partial protections” into a group of 10 states with “comprehensive protections.” The measure will protect a good chunk of Coloradans, but it may not apply to certain insurance plans, such as self-funded plans not governed by state law. https://www.kunc.org/post/colorado-join-other-states-increased-consumer-protection-against-surprise-medical-bills#stream/0
On a national level, there are some federal bills in the early stages of introduction to the House and Senate that address balance-billing. https://www.nbcnews.com/politics/congress/dem-gop-senators-say-they-have-fix-surprise-medical-bills-n1006056
If you or your employees are experiencing an escalated claim concern, please reach out to your Fall River Client Manager for help.
