Dispute resolution; notice of rights

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20-3117. Dispute resolution; notice of rights

A. The department in conjunction with the appropriate health care boards shall prescribe the notice outlining an enrollee's rights to dispute surprise out-of-network bills under this article.

B. Health insurers shall include the notice prescribed pursuant to subsection A of this section in each explanation of benefits or other similar claim adjudication notice that is issued to enrollees and that involves covered services provided by a noncontracted health care provider.

C. If an enrollee contacts a health care provider, a provider's representative or a billing company regarding a dispute involving a surprise out-of-network bill, the health care provider, the provider's representative or the billing company shall provide written notice as prescribed in subsection A of this section to the enrollee of the dispute resolution process.

D. The department shall post on its website information for health care consumers regarding what constitutes a surprise out-of-network bill, how to try to avoid a surprise out-of-network bill and how the dispute resolution process may be used to resolve a surprise out-of-network bill.


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