Senate committee substitute amends the 1st edition as follows.
Modifies new GS 58-3-295 to eliminate the proposed procedure under which an insurer may recover overpayments made to the health care provider or facility under the new statute. Makes conforming organizational changes.
Bill S 505 (2021-2022)Summary date: Apr 22 2021 - View summary
Bill S 505 (2021-2022)Summary date: Apr 5 2021 - View summary
Includes whereas clauses.
Enacts new GS 58-3-295 to require all contracts or agreements for participation as an in-network health services facility between an insurer offering health benefit plans in this state and a health services facility at which there are out-of-network providers who may be providing services to an insured person receiving care at the facility, to require that an in-network health services facility give at least 72 hours' advanced written notice to an insured with a scheduled appointment of any out-of-network provider who will be part of providing care. Sets out alternate requirements for timing of notice in situations in which there is not 72 hours between the appointment and when it is scheduled or when there is an emergency. Requires the notice to include: (1) all of the health care providers that will be rendering services who are not in-network and (2) the estimated cost to the insured of the services being rendered by those out-of-network providers. Sets out the procedure under which an insurer may recover overpayments made to the provider or facility. Defines a health care provider as any individual licensed, registered, or certified under GS Chapter 90, or under another state's laws, to provide health care services in the ordinary care of business or practice, as a profession, or in an approved education or training program in: (1) anesthesia or anesthesiology, (2) emergency services, (3) pathology, (4) radiology, or (5) rendering assistance to a physician performing any of these services.
Applies to contracts entered into, amended, or renewed on or after January 1, 2022.