SF 4700

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/24/2026 10:49 a.m.

A bill for an act
relating to health insurance; limiting the amount a provider can charge an enrollee
for denied covered services; proposing coding for new law in Minnesota Statutes,
chapter 62Q.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62Q.495] PAYMENT FOR DENIED COVERED SERVICES.
new text end

new text begin (a) If a health plan company denies coverage, for procedural reasons, for a health care
service that is a covered benefit under an enrollee's health plan, the provider may not charge
the enrollee for the denied service more than the negotiated provider payment amount plus
20 percent.
new text end

new text begin (b) Any amount paid by the enrollee to a provider in accordance with paragraph (a) shall
be counted toward any applicable deductible amount for which the enrollee is responsible
under the enrollee's health plan.
new text end

new text begin (c) Nothing in this section requires a health plan company to:
new text end

new text begin (1) pay for services provided by an out-of-network provider unless required under the
terms of the enrollee's health plan; or
new text end

new text begin (2) provide coverage for services not covered under the enrollee's health plan.
new text end

new text begin (d) For purposes of this section, "negotiated provider payment" means the payment the
provider agrees to accept under the provider contract entered into by the provider and the
health plan company for health care services provided by the provider to an enrollee covered
by the health plan.
new text end