The bill amends sections 1753.28 and 3923.65 of the Revised Code and enacts new sections 1753.29 and 3923.66, aimed at protecting enrollees of health insuring corporations and sickness and accident insurers from claim reductions or denials based on specific criteria. Notably, the bill prohibits these insurers from reducing or denying claims solely based on diagnosis codes, current ICD codes, the duration of appointments deemed clinically necessary by the provider, or specific procedure codes. Additionally, it ensures that claims cannot be denied based on the absence of an emergency medical condition if a prudent layperson would have reasonably expected such a condition to be present.

The bill also emphasizes the importance of emergency services coverage, mandating that health insuring corporations and sickness and accident insurers provide coverage for emergency services without regard to prior authorization or the time of service. It requires these insurers to inform enrollees about the scope of emergency services, appropriate usage, and any cost-sharing provisions, while also clarifying that enrollees are not required to self-diagnose. The existing sections 1753.28 and 3923.65 are repealed, reflecting the updates and changes made by this legislation.

Statutes affected:
As Introduced: 1753.28, 3923.65