Budget Amendment ID: FY2020-S3-618

EHS 618

GIC Balance Billing

Messrs. Cyr, Eldridge, Welch, Moore and Feeney moved that the proposed new text be amended by striking section 15 and inserting in place thereof the following section:-

SECTION 15. Chapter 32 is hereby amended by striking out section 20 and inserting in place thereof the following section:-

Section 20. No physician or other provider of services, who treats or provides services to an individual covered by hospital, surgical, medical or catastrophic illness coverage offered by the commission under section four, four A, ten B, twelve or fifteen, shall charge to or collect from any insured or other beneficiary any amount in excess of that amount of compensation determined or allowed for a particular service by the insurer or by the administrator. For purposes of this section the words insurer and administrator shall include any insurance carrier, nonprofit hospital or medical service corporation or third-party health care administrator operating within the scope of its license. Nothing in this section shall be construed to prevent the collection of any copayments or deductibles allowed for in the plan design; provided however, that if out of network services are provided to an insured, a physician or other provider of services shall bill the carrier directly and the carrier shall pay for such services as coded and billed by the physician or other provider of services within 30 calendar days of the submission of the claim; and provided further, that the insured’s applicable copayment, coinsurance or deductible for out of network services shall be limited to the amount that the Insured would have paid the physician or other provider of services for In-Network services.