HB 193: "An Act relating to insurance trade practices and frauds; and relating to emergency services and balance billing."
00 HOUSE BILL NO. 193 01 "An Act relating to insurance trade practices and frauds; and relating to emergency 02 services and balance billing." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 21.36 is amended by adding a new section to read: 05 Sec. 21.36.512. Emergency services; balance billing. (a) A health care 06 insurer that offers, issues for delivery, delivers, or renews in this state a health care 07 insurance plan that provides coverage for emergency services or treatment of an 08 emergency medical condition under AS 21.07.020 may not balance bill for services 09 that results in a covered person's incurring greater out-of-pocket costs, including 10 copayment, deductible, or coinsurance amounts, for emergency services or treatment 11 of an emergency medical condition from a non-network health care provider than the 12 covered person would have incurred from a health care provider that furnishes 13 emergency services or treatment of an emergency medical condition through a 14 network of health care providers that have entered into a contract with the health care
01 insurer. 02 (b) Except as provided in (d) of this section, a health care insurer that offers, 03 issues for delivery, delivers, or renews in this state a health care insurance plan shall 04 pay a non-network health care provider in accordance with (c) of this section if a non- 05 network health care provider renders services to a covered person 06 (1) at an in-network hospital or ambulatory surgical center, where 07 (A) an in-network health care provider is unavailable; 08 (B) a non-network health care provider renders services without 09 the consent of the covered person; or 10 (C) unforeseen medical services arise at the time services are 11 rendered; or 12 (2) where services were referred by an in-network health care provider 13 to a non-network health care provider without explicit written consent of the covered 14 person acknowledging that the in-network health care provider is referring the covered 15 person to a non-network health care provider and that the referral may result in costs 16 not covered by the health care insurance plan. 17 (c) If a non-network health care provider renders services to a covered person 18 under (b) of this section, 19 (1) the covered person may only be required to pay the copayment, 20 deductible, or coinsurance amounts or other out-of-pocket expenses that would be 21 imposed for those services if those services were rendered by an in-network health 22 care provider; and 23 (2) the health care insurer shall pay the non-network health care 24 provider the in-network rate under the health care insurance plan of the covered person 25 as payment in full, unless the health care provider and health care insurer agree 26 otherwise. 27 (d) A health care insurer is not required to pay a non-network health care 28 provider under (b) or (c) of this section if an in-network health care provider is 29 available to render services to a covered person and the covered person knowingly 30 elects to obtain those services from a non-network health care provider. 31 (e) In this section,
01 (1) "ambulatory surgical center" has the meaning given in 02 AS 47.32.900; 03 (2) "emergency medical condition" has the meaning given in 04 AS 21.07.250; 05 (3) "health care insurer" has the meaning given in AS 21.54.500; 06 (4) "health care provider" has the meaning given in AS 21.07.250.