Maine § 24-A §4303-C Protection from surprise bills and bills for out-of-network emergency services

Maine Statutes

§ 24-A §4303-C — Protection from surprise bills and bills for out-of-network emergency services

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 56-A HEALTH PLAN IMPROVEMENT ACT

1.Surprise bill defined. As used in this section, unless the context otherwise indicates, "surprise bill" means a bill for health care services, including, but not limited to, emergency services, received by an enrollee for covered services rendered by an out-of-network provider, when such services were rendered by that out-of-network provider at a network provider, during a service or procedure performed by a network provider or during a service or procedure previously approved or authorized by the carrier and the enrollee did not knowingly elect to obtain such services from that out-of-network provider. "Surprise bill" does not include a bill for health care services received by an enrollee when a network provider was available to render the services and the enrollee knowingly elected t

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1.
Surprise bill defined.
As used in this section, unless the context otherwise indicates, "surprise bill" means a bill for health care services, including, but not limited to, emergency services, received by an enrollee for covered services rendered by an out-of-network provider, when such services were rendered by that out-of-network provider at a network provider, during a service or procedure performed by a network provider or during a service or procedure previously approved or authorized by the carrier and the enrollee did not knowingly elect to obtain such services from that out-of-network provider. "Surprise bill" does not include a bill for health care services received by an enrollee when a network provider was available to render the services and the enrollee knowingly elected to obtain the services from another provider who was an out-of-network provider.
1-A.
"Knowingly elected to obtain such services from that out-of-network provider" defined.
As used in this section, unless the context otherwise indicates, "knowingly elected to obtain such services from that out-of-network provider" means that an enrollee chose the services of a specific provider, with full knowledge that the provider is an out-of-network provider with respect to the enrollee's health plan, under circumstances that indicate that the enrollee had and was informed of the opportunity to receive services from a network provider but instead selected the out-of-network provider. The disclosure by a provider of network status does not render an enrollee's decision to proceed with treatment from that provider a choice made knowingly pursuant to this subsection.
2.
Requirements.
With respect to a surprise bill or a bill for covered emergency services rendered by an out-of-network provider:
3.
Payment after resolution of disputes.
Following an independent dispute resolution determination pursuant to section 4303‑E, the determination by the independent dispute resolution entity of a reasonable payment for a specific health care service or treatment rendered by an out-of-network provider is binding on a carrier, out-of-network provider and enrollee for 90 days. During that 90-day period, a carrier shall reimburse an out-of-network provider at that same rate for that specific health care service or treatment, and an out-of-network provider may not dispute any bill for that service under section 4303‑E.

Maine § 24-A §4303-C (Protection from surprise bills and bills for out-of-network emergency services) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Legislative History

PL 2017, c. 218, §2 (NEW). PL 2017, c. 218, §3 (AFF). PL 2019, c. 668, §2 (AMD). PL 2021, c. 222, §1 (AMD). PL 2021, c. 241, §2 (AMD). PL 2023, c. 591, §§1, 2 (AMD).