This bill proposes new regulations regarding health insurance coverage in Minnesota, specifically addressing the financial responsibilities of enrollees when a health plan company denies coverage for a service that is otherwise a covered benefit. Under the new section [62Q.495] PAYMENT FOR DENIED COVERED SERVICES, if a health plan denies coverage for procedural reasons, the provider is limited in how much they can charge the enrollee. The charge cannot exceed the negotiated provider payment amount plus 20 percent. Additionally, any amount paid by the enrollee for these denied services will count towards their deductible under their health plan.
The bill also clarifies that health plan companies are not obligated to pay for services provided by out-of-network providers unless specified in the enrollee's health plan, nor are they required to cover services that are not included in the plan. The term "negotiated provider payment" is defined to mean the amount agreed upon between the provider and the health plan for services rendered to the enrollee. This legislation aims to protect enrollees from excessive charges for denied services while maintaining the health plan companies' rights regarding coverage limitations.