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30th Legislature(2017-2018)

Bill Text 30th Legislature


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.                                       
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