Increased Penalties for Health Plans Violating Surprise Billing Rules and Late Payments.
This Act significantly increases financial penalties for health plans and insurers that violate the rules prohibiting surprise medical bills (balance billing). It introduces a triple penalty for insurers who delay or fail to make payments after an amount is determined by an independent dispute resolution (IDR) entity. Citizens gain stronger protection against unfair billing practices, and healthcare providers have greater assurance of timely payment, aiming to stabilize the system.
Key points
Penalties for health plans violating surprise billing prohibitions (balance billing) are increased to $10,000 per failure.
A severe new penalty is introduced for late or non-payment after an IDR determination: the plan must pay three times the difference between the initial offer and the final determined rate.
Increased transparency requirements mandate the government to submit detailed reports every six months on audits, complaints, and enforcement actions taken against health plans.
Expired
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