2007 Minnesota Statutes

62J.81 DISCLOSURE OF PAYMENTS FOR HEALTH CARE SERVICES.
    Subdivision 1. Required disclosure of estimated payment. (a) A health care provider, as
defined in section 62J.03, subdivision 8, or the provider's designee as agreed to by that designee,
shall, at the request of a consumer, and at no cost to the consumer or the consumer's employer,
provide that consumer with a good faith estimate of the allowable payment the provider has
agreed to accept from the consumer's health plan company for the services specified by the
consumer, specifying the amount of the allowable payment due from the health plan company.
Health plan companies must allow contracted providers, or their designee, to release this
information. If a consumer has no applicable public or private coverage, the health care provider
must give the consumer, and at no cost to the consumer, a good faith estimate of the average
allowable reimbursement the provider accepts as payment from private third-party payers for the
services specified by the consumer and the estimated amount the noncovered consumer will be
required to pay. Payment information provided by a provider, or by the provider's designee as
agreed to by that designee, to a patient pursuant to this subdivision does not constitute a legally
binding estimate of the allowable charge for or cost to the consumer of services.
    (b) A health plan company, as defined in section 62J.03, subdivision 10, shall, at the request
of an enrollee or the enrollee's designee, provide that enrollee with a good faith estimate of the
allowable amount the health plan company has contracted for with a specified provider within the
network as total payment for a health care service specified by the enrollee and the portion of
the allowable amount due from the enrollee and the enrollee's out-of-pocket costs. An estimate
provided to an enrollee under this paragraph is not a legally binding estimate of the allowable
amount or enrollee's out-of-pocket cost.
    Subd. 2. Applicability. For purposes of this section, "consumer" does not include a medical
assistance, MinnesotaCare, or general assistance medical care enrollee, for services covered
under those programs.
History: 2004 c 288 art 7 s 3; 2006 c 255 s 24; 2007 c 147 art 15 s 9