In Ohio, HB 388 is scheduled for a hearing before the Senate Committee on Insurance and Financial Institutions. The bill would require carriers to reimburse out-of-network providers for emergency out-of-network care for services provided to an enrollee at an in-network or out-of-network facility.
The reimbursement would be the greatest of the following amounts:
- In-network amount in the geographic region under the issuer.
- Amount for service calculated generally used to determine out-of-network services, such as the usual, customary and reasonable amount.
- Medicare reimbursement fee.
Providers would be prohibited from charging enrollees for the difference between the carrier’s reimbursement and provider’s charge for emergency out-of- network care services. Carriers would be prohibited from charging enrollees at a rate higher than the in-network service rate.
Out-of-network providers at an in-network facility would be permitted to charge the difference between the carrier’s out-of-network reimbursement and provider’s charge if:
- The provider informs the enrollee that the provider is not in-network;
- The provider provides to the enrollee a good faith estimate of the cost of services, including a disclaimer the enrollee is not required to obtain service from that provider; and
- The enrollee consents to receive the services.
In the event of a payment dispute, both parties may request for arbitration to the superintendent of insurance. The non-prevailing party would pay 70% of the fees, and the remaining 30% would be paid by the prevailing party.