SB 87 introduced by Senator Miller mainly adds notice requirements to direct payments made by an insurance company to its insured for services provided by a medical provider that has not entered into a contractual relationship with that insurer. The insurer is required to notify the insured that the insured is to send the money to the medical provider if the bill has not already been paid.
So, for example, Insurer does not have a contractual arrangement with Hospital. Patient gets treated at Hospital. So, Insurer sends money directly to Patient instead of to Hospital. The danger is that the patient will not use the money to pay his or her medical bills. Of course, even with notice, not all patients will use the money to pay the medical bills. But, there is only so much the law can do. I actually had a case like this (pdf) go to the Court of Appeals recently.
SB 87 also has a provision that confuses me a bit:
If an insured does not have a choice of a contracted provider and receives from a noncontracted provider:
(1) emergency health care services; or
(2) other health care services directly related to the condition that causes the insured to receive the health care services described in subdivision (1);
the noncontracted provider shall not bill the insured for any amount owed for the health care services by the insurer or a contracted provider.
If the health care provider does not have a contract with the insurer, how does the health care provider know how much the insurer owes on behalf of the patient and, therefore, the amount it is prohibited from billing the patient?
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