FIVE FACTS ABOUT THE EMERGENCY CARE BILL HOSPITALS MUST FOLLOW

• An Out of Network provider cannot charge more than the copayment, coinsurance  or  deductible  required of your network providers for emergency care;
• If you are stable, an out-of-network hospital must transfer you to an in network provider within 24 hour of admission;
• If the hospital had a contract within the preceding 12 months that was terminated, the health insurer is required to pay as if they were still on the plan and the hospital must accept.
• Hospitals are required to negotiate directly with the insurance company;
• Medicaid patients are exempt from the bill.

Nevada Gov. Steve Sisolak has signed a law to protect patients from “surprise medical bills” after emergency treatment.  The legislation puts limits on the cost an out-of-network provider can charge a patient for specific medically necessary emergency services. That cost under this legislation is limited to a patient’s insurance copay, coinsurance or deductible.  The bill has a provision for a process that determines the amount of reimbursement from insurers out-of-network providers can charge for emergency services.  In addition, it is a required process for out-of-network providers to transfer patients to a hospital that is in the patient’s insurance network within 24 hours.

This  legislative action that reforms billing practices was signed into law by Governor Sisolak on May 15, 2019 and  limits the amount a provider of health care may charge a person who has health insurance for certain medical emergency services provided when the provider is out-of-network.   The bill is comprised of several sections including a provision that requires an insurer to arrange for the transfer of a person who has health insurance to an in-network facility under certain circumstances.  It also has provisions for determining the amount that an insurer (aka the health insurance company) is required to pay an out of network provider for specific medically necessary emergency services.  When such services are provided to a patient, there are also provisions  that require the reporting of certain information related to the treatment.

The complete bill can be reviewed at: https://www.leg.state.nv.us/App/NELIS/REL/80th2019/Bill/6896/Text

Currently, under Nevada  Law,  a  hospital  is  required  to  provide  emergency  services  and treatment  (including admission to the hospital when needed) to certain  patients, regardless  of  the  financial  status  of  the  patient.  (See NRS  439B.410)  Existing  law  further requires  specific major hospitals  to  reduce  total  billed  charges  by  at  least  30  percent  for  hospital  services provided  to  certain  patients  who  have  no  insurance  or  other  contractual  provision for  the  payment  of  the  charges  by  a  third  party,  which  is  an  insurer.  (NRS 439B.260) The  bill  defines the phrase  “out of network provider” “as for a particular person covered by a policy of health insurance, a provider of health care or medical facility that has not entered into a contract with a third party for the provision of health care to persons who are covered by a policy of insurance issued  by  that  third  party.”

This bill is a much needed addition to Nevada Healthcare law and  protect patients from “surprise” medical bills.  Much more healthcare reform is needed in Nevada to protect patients.  Below is an outline of the recently passed legislation:

Section 11 — This section exempts  services  provided  to recipients  of  Medicaid  from  the  provisions  of  this  bill.

Section 13 –This section exempts a critical access hospital and a person covered by a policy of insurance sold outside Nevada from the provisions of this bill.

Section 14–This section prohibits an out of network provider from collecting  against a  person  covered  by  a  policy  of  health  insurance  an  amount  for  medically  necessary  emergency  services that  exceeds  the  copayment,  coinsurance  or  deductible  required  by  that  policy. In addition, Section 14 also requires an out of network hospital  or  independent  center  for emergency medical care that provides medically necessary emergency services to a covered person to notify the third party that provides coverage for the person that:

(1) the  person  is  receiving  such  services  at  the  facility;  and

(2) the  person’s emergency  medical  condition  is  stabilized not  later  than  24 hours  after  such stabilization  occurs.

Section  14 further requires  the  third  party  to  arrange  for  such  a transfer to an in network hospital or independent center for emergency medical care

not later than 24 hours after receiving such notice. If an out of network hospital or independent center for emergency medical care had  a  contract  as  an  in network hospital  or  independent  center  for  emergency medical  care  with  the  third  party  that  provides  coverage  for  the  covered  person within  the  12  months immediately  preceding  the  provision of  medically  necessary emergency  services  to  a  covered  person.

section  15 of  this  bill  requires  the  third party to pay, and the hospital or independent center for emergency medical care to accept,  as  compensation  for  those  services  an  amount  based  on  the  amount  that would have been paid for those services under the most recent contract between the third party and the hospital or independent center for emergency medical care. If an out of network hospital  or  independent  center  for  emergency  medical  care  did  not have a contract as with the third party that provides coverage for the covered person as an in network hospital or independent center for emergency medical care during that time, section 15requires the third party to pay to the provider an amount that the  third  party  has  determined  to  be  fair  and  reasonable  as  payment for  the  medically  necessary  emergency  services.

Section  16 has similar provisions   applicable to   out of network   providers,   other   than   hospitals   and independent centers for emergency medical care. Specifically, if an out of network provider had a contract as an in network provider with the third party that provides coverage  for  the  covered  person  within  the  12  months  immediately  preceding  the provision of medically necessary emergency services to a covered person

that was not terminated by the third party for cause, this section requires the

third party  to  pay,  and  the  provider  to  accept,  as  compensation  for  those services  an

amount based on the amount that would have been paid for those services under the

most recent contract between the third party and the provider. If an out of network

provider did not have a contract with the third party that provides coverage for the

covered person as an in network provider during that time or if such a contract was terminated by the third party for cause section 16 requires the third party to pay to  the provider an amount that the third party has determined to be fair and reasonable as payment for the medically necessary emergency services.

Section 17 – Requires that the out of network  providers request  from  the  third  party an additional amount which, when combined with the amount previously paid, the out of network  provider  is  willing  to  accept as  payment  in  full  and if  not paid, the parties are required to submit the dispute to binding arbitration. This section also states that interest cannot accrue on a claim during the arbitration process.

Sections 21 – 27of this bill make conforming changes.   Sections 17,  19and  20 of  this  bill  provide  for  the  confidentiality  of  the  decisions  of  arbitrators  and  documents associated with arbitration.

Section 18  of this bill authorizes certain health insurers not included in this bill to opt in to the provisions of the bill.

Section 19 of  this  bill  provides  for  the  annual  reporting  of  certain  information  concerning arbitrations conducted.

At the Law Offices of Laura Payne-Hunt, TheOneLawyer.com, we provide professional and personal service to each and every one of our clients on various legal matters.  We have over 15 years of experience in reviewing insurance policies and in Nevada insurance law.   If you have a question regarding any type of personal injury or paying your medical bills from an accident, please don’t hesitate to call the offices of TheOneLawyer.com and speak directly to attorney Laura Marie Payne-Hunt, Esq. a Henderson Injury Attorney for over 15 years.  Laura is recognized as one of Nevada’s Top 100 Lawyers.  She has the experience and knowledge to obtain the maximum settlement you deserve.  Please call our office if you or a loved one is injured.  We can make sure that you receive the care you need and deserve and advise on how to preserve evidence.

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