This part of the bill is about making the arbitration process more efficient for out-of-network health insurance claims.
Arbitration for Out-of-Network Claims: When a healthcare provider is not part of an insurance carrier’s network, disputes over payment can go to arbitration, which is a process to resolve disagreements without going to court.
Batching Process: The bill introduces a system where multiple similar claims can be grouped together (or “batched”) and handled as a single arbitration case. This means:
All batched claims are considered together.
Only one arbitration fee is charged for the entire batch.
This aligns with federal law, likely referencing the No Surprises Act, which established similar protections for patients and processes for resolving out-of-network payment disputes.
Commissioner of Insurance Rules: The bill requires the state’s commissioner of insurance to create rules specifying what information insurance companies must give to healthcare providers when they make an initial payment on a claim. This could include details like how the payment amount was determined, which can help providers understand and dispute payments if necessary.
Overall, this bill aims to streamline dispute resolution, reduce costs associated with multiple arbitrations, and ensure transparency in how insurance payments are communicated to providers.
Summary
The bill makes changes to the arbitration requirements for
out-of-network health insurance claims by requiring the arbitration process to include a batching process, by which multiple claims may be considered jointly and under the same arbitration fee as part of one payment determination in alignment with federal law. The commissioner of insurance is required to adopt rules that specify the information each insurance carrier is required to submit to a provider with the initial payment of a claim.
