Health insurance; prohibiting insurers from refusing coverage under certain circumstances; requiring out-of-network providers be reimbursed at the same rate as in-network providers. Emergency.
Impact
The legislation is expected to facilitate better access to necessary medical supplies for patients residing in areas where in-network providers are not readily available. By mandating that out-of-network providers be reimbursed at the same rates as their in-network counterparts, SB17 aims to create a more equitable healthcare environment for patients who may face urgent needs. This could potentially lead to improved health outcomes, as patients would be less likely to delay necessary medical care due to insurance-related barriers.
Summary
Senate Bill 17 (SB17) seeks to enhance access to healthcare by prohibiting insurers from denying coverage for durable medical equipment and supplies as prescribed by healthcare providers, irrespective of the provider's network status. The bill specifically stipulates that if a patient does not have an in-network provider available within a thirty-mile radius, their insurer must cover the costs incurred when they obtain the necessary equipment from an out-of-network provider. This provision is aimed at ensuring that patients have timely access to essential medical equipment without being constrained by their insurance networks.
Contention
Despite its intent to improve access to care, SB17 may face scrutiny from insurance companies concerned about the financial implications of the mandated reimbursement rates for out-of-network providers. Insurers may argue that this could lead to increased costs and impact premium rates. There could also be concerns from healthcare networks about the potential for increased patient flow to out-of-network providers which may disrupt established patient-provider dynamics and negotiations over reimbursement terms.
Carry Over
Health insurance; prohibiting insurers from refusing coverage under certain circumstances; requiring out-of-network providers be reimbursed at the same rate as in-network providers. Emergency.
Health insurance; prohibiting insurers from refusing coverage under certain circumstances; requiring out-of-network providers be reimbursed at the same rate as in-network providers. Emergency.
Behavioral health; requiring health insurer to cover certain out-of-network services under certain circumstances; providing exceptions. Effective date.
Health insurance coverage; requiring health benefit plans to provide coverage for at home care for persons with certain conditions; specifying terms of coverage. Effective date.
Pharmaceuticals; prohibiting certain drug plans to refuse dispensing certain drugs under certain circumstances; requiring certain drugs meet certain federal requirements; prohibiting patients from payment of certain fees beyond cost-sharing obligation; establishing penalties. Effective date. Emergency.