Public Act 15-146 requires that if emergency services are rendered to an insured by an out-of-network health care provider, such health care provider may bill the health carrier directly. The health carrier shall reimburse such health care provider the greatest of the following amounts: (i) The amount the insured's health care plan would pay for such services if rendered by an innetwork health care provider; (ii) the usual, customary and reasonable rate for such services, or (iii) the amount Medicare would reimburse for such services.
"Usual, customary and reasonable rate" means the eightieth percentile of all charges for the particular health care service performed by a health care provider in the same or similar specialty and provided in the same geographical area, as reported by FAIR Health, Inc. View the full notice here.
CSMS Affinity Partner FAIR Health offers a 10% discount to CSMS members.
