SF 824

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/26/2021 10:10am

A bill for an act
relating to health insurance; requiring providers to charge enrollees the negotiated
provider payment; proposing coding for new law in Minnesota Statutes, chapter
62Q.

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

Section 1.

[62Q.495] PAYMENT FOR DENIED COVERED SERVICES.

(a) If a health plan company denies coverage for a health care service that is a covered
benefit under an enrollee's health plan for procedural reasons, including but not limited to
failure to receive prior authorization, the provider may not charge the enrollee for the denied
service more than the negotiated provider payment.

(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.

(c) Nothing in this section requires a health plan company to pay for services provided
by an out-of-network provider unless required under the terms of the enrollee's health plan,
or to provide coverage for services not covered under the enrollee's health plan.

(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.