GOVERNOR SISOLAK HELPS NEVADANS BY SIGNING HEALTH BILL PRACTICES BILL

FIVE FACTS ABOUT THE EMERGENCY CARE BILL HOSPITALS MUST FOLLOW

  1. An Out of Network provider cannot charge more than the copayment,  coinsurance or  deductible required of your network providers for emergency care;
  2. If you are stable, an out-of-network hospital must transfer you to an in network provider within 24 hour of admission;
  3. 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.
  4. Hospitals are required to negotiate directly with the insurance company;
  5. 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.  

At our office, we are experienced in helping injured victims get the compensation they are entitled to.  Insurance companies never have the best interest of the injured person at the top of their priorities. They want to pay as little on every claim as possible.  Having worked for an insurance company as an attorney for 9 years before opening my boutique law firm specializing in helping injured people, I have reviewed thousands of auto accident claims and policy provisions.   

At the Henderson and Las Vegas Accident injury law offices of TheOneLaweyer.com, Laura Marie Payne-Hunt and her staff are here to help you and your family in the event that accidents and tragedies occur.  For any of your legal needs, do not hesitate to contact our Henderson and Las Vegas Accident injury offices. TheOneLawyer.com is a boutique, family owned law firm that specializes in helping injured people and the community of Las Vegas and Henderson Nevada with legal issues involving auto accidents, wrongful deaths, slip and falls, truck accidents, injuries to children, bicycle accidents, dog bites, product liability claims, and all types of injury claims.  Please do not hesitate to call us anytime you have a legal question or you or a loved one has sustained an injury at 702-450-(HUNT) 4868 and text 24/7 at 702-600-0032.