This bill proposes several amendments to current law regarding patient rights and health care claims processing. It requires that patients be informed and given the right to refuse participation in any human-subjects research, with exceptions for life-threatening situations. The bill also includes provisions regarding patient rights, such as the right to examine and receive an explanation of their medical bill, the right to not be denied care based on certain characteristics, and the right to receive a summarized medical bill within 30 days of discharge. It also amends the requirements for prompt processing of health care claims, establishing timeframes for payment of complete claims and requiring notification of any reasons for denying or pending a claim.

This bill amends current law to require healthcare entities and health plans operating in the state to pay all complete claims for covered healthcare services within 40 calendar days of receipt of a complete written claim or 30 calendar days of receipt of a complete electronic claim. The bill also establishes that no healthcare entity or health plan can deny a claim for a medical bill solely based on the reason that the bill may arise from a motor vehicle accident or other third-party claim, except for bills arising from a worker's compensation claim. Additionally, the bill defines "policyholder" as a person covered under a health plan or a representative designated by that person. It also includes provisions for exceptions to the requirements of prompt processing of claims and allows healthcare entities and health plans to petition for a waiver of the prompt processing requirements for a period not to exceed 90 days if they are converting or substantially modifying their claims processing systems.

Statutes affected:
7143: 5-37-5.1, 23-17-19.1, 27-18-61, 27-19-52, 27-20-47, 27-41-64