August 26, 2020

Puerto Rico Passes Out-of-Network Billing Law

Puerto Rico’s House and Senate passed a bill that would modify out-of-network provider reimbursement. California advances its scope of practice expansion for nurse practitioners.

Out-of-Network Billing

In Puerto Rico, both chambers cleared S 1528, legislation on out-of-network billing, for the governor’s signature.

The bill would require providers to inform enrollees whether they are out-of-network before scheduling an appointment. For elective services, an out-of-network provider would be required to provide a cost estimate before the procedure in writing.

In the event of an emergency service, the facility and provider would be prohibited from charging an enrollee in excess of the deductible, copay or coinsurance that would be applicable to the in-network rate.

Out-of-network providers would be allowed to charge the enrollee’s insurer for emergency services. The insurer would have 30 days to pay the amount or offer a counteroffer for the in-network rate. In the event of a dispute, both parties would proceed to arbitration where an arbitrator would present a final offer. Both parties would pay arbitration costs equally unless the arbitrator determines the insurer did not act in good faith, in which case the insurer would be responsible for all costs.

Scope of Practice

In California, AB 890 is scheduled for a third reading on the Senate floor. The measure seeks to remove the mandatory physician supervision of nurse practitioners and to expand their scope of practice. The California Radiological Society is diligently working towards an amendment and is doing everything in its power to educate the stakeholders on provision of quality diagnostic imaging services. For questions, please contact Eugenia Brandt at