New Bulletin on Balance Billing and Network Adequacy

On July 25, 2019, the Insurance Department published Bulletin Docket No. INS. No. 19-015-AB. The new bulletin relates to a 2018 law (HB 1809) that is aimed at protecting patients from surprise medical bills (sometimes referred to as “balance billing”) by certain hospital based providers, which became effective July 1, 2018. The 2018 law expands NH’s balance protections by prohibiting anesthesiologists, radiologists, pathologists, and emergency medicine providers from billing patients for more than regular cost sharing when a patient is treated at an in-network hospital or ambulatory surgery center, even if the provider is out-of-network. When the providers listed above are not participating in the carrier network, the carrier must provide for a commercially reasonable amount to be paid to the provider, provider group, or provider employer. This will help provide balance in the dispute between providers and carriers, and will help curb the surprise medical bill issue in NH.

The law also requires the Department’s network adequacy rules to include standards for addressing in-network access to hospital-based providers such as those listed above. In response, the Department amended its network adequacy rule to require that carriers assure that providers whose services are integral to care in a hospital or similar facility either be included in their networks or provided without additional cost sharing.

None of the above rules apply specifically to an employer. So, the bulletin does not create any new employer compliance obligations. But NH employers will want to be aware of the application of the new law and bulletin guidance on surprise medical billing and network adequacy.

Bulletin Docket No. INS. No. 19-015-AB »