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Relating to physician and health care practitioner credentialing by managed care plan issuers.
No significant fiscal implication to the State is anticipated.
Under current law, healthcare providers are required to undergo a credential process for becoming in-network providers.
HB 2631 would make a number of changes that would attempt to expedite the credentialing process for health care practitioners by managed care organizations.
The bill would protect enrollees from liability for the difference between in-network and out-of-network costs for treatment received from a practitioner who does not meed the organization's credentialing requirements The bill would create a new audit system under which the issuer would be required to provide a notice in the event of a failure to meet a credential requirement.
Additionally, the bill would require the office of public insurance counsel to, within existing resources, publish certain managed care organization information on its internet website.
HB 2631 is one of a series of bills which attempt to address the issue of "balance billing" or "surprise billing" in which an individual receives services at an in-network facility covered by their insurance plan only to find out later that their treatment was provided by a health care professional who is out-of-network, leading to the unpleasant surprise of receiving a bill with a balance due for the difference between the total bill and the portion the insurance company paid for. This system of balance billing only exists because health care and health insurance do not operate in a free market environment. We would prefer to see balance billing ended by moving these industries into a free market environment which fosters consumer choice through competition. In the meantime, we do not oppose legislation designed to protect consumers from this abusive practice.