Relating to the disclosure of the calculation of out-of-network payments by the issuers of preferred provider benefit plans and by health maintenance organizations.
Impact
The implementation of HB 1406 is expected to impact the Insurance Code by adding specific requirements for health maintenance organizations and insurers regarding payment calculation disclosures. This change seeks to simplify the process for enrollees wishing to ascertain how much they will need to pay when using out-of-network providers, thereby improving consumer confidence in their healthcare choices. Furthermore, the bill introduces accountability on the part of HMOs and insurers by compelling them to maintain transparency surrounding their pricing strategies.
Summary
House Bill 1406 is designed to enhance transparency in the disclosure of the calculation of out-of-network payments. It mandates that health maintenance organizations (HMOs) and insurers disclose the methodologies they use to calculate payments for services provided by non-participating providers. By requiring these organizations to provide detailed breakdowns, the bill aims to equip consumers with the necessary information to understand their anticipated out-of-pocket responsibilities for out-of-network healthcare services. This is particularly important in scenarios where individuals seek treatment from providers who are not part of their health maintenance organization's network.
Contention
One of the notable points of contention regarding HB 1406 revolves around the adequacy of the disclosed information. Critics may argue that while the bill mandates disclosures, it does not guarantee that the information provided will be easy for consumers to understand or comprehensive enough to truly inform them of potential costs. Supporters, however, view the bill as a crucial step toward empowering consumers and encouraging competitive pricing among providers. As the healthcare landscape becomes increasingly complicated, ensuring that individuals are well-informed about their financial obligations is increasingly seen as a necessary measure.
Identical
Relating to the disclosure of the calculation of out-of-network payments by the issuers of preferred provider benefit plans and by health maintenance organizations.
Relating to health maintenance organization and preferred provider benefit plan minimum access standards for nonemergency ambulance transport services delivered by emergency medical services providers; providing administrative penalties.
Relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician or health care provider.