Minnesota Law Tackles Out-of-Network Billing

Minnesota has joined a list of states that are taking action to address out-of-network billing by insurers. Out-of-network billing and network adequacy have increasingly become a concern as insurers continue to narrow their provider networks, making it difficult for patients to access in-network providers. The law provides that patients will not be financially responsible for "non-authorized provider services" that occur when a patient receives services from a non-participating provider at a participating facility. In addition, the law provides that the patient will not be financially responsible for out-of-network costs when a participating provider sends a specimen to a non-participating laboratory, pathologist or other medical facility. Specifically, the measure states: "An enrollee's financial responsibility for the unauthorized provider services shall be the same cost-sharing requirements, including co-payments, deductibles, coinsurance, coverage restrictions and coverage limitations, as those applicable to services received by the enrollee from a participating provider. The new law takes effect 90 days after enactment. The new Minnesota law is similar to existing law in Illinois and in Florida governing out of network billing by facility based providers. Recently, the CAP and state pathology societies have urged states to consider similar legislation, including Washington State.

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