Final
Evaluation of Nonparticipating Providers
COMMITTEE ON
JOINT BUSINESS AFFAIRS & LABOR
Votes:
Action Taken:
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02:26 PM -- Presentation by the Commissioner of Insurance of a Report on Nonparticipating Health Care Providers
Doug Dean, Commissioner of Insurance, presented the Evaluation of Nonparticipating Providers, as required by HB 04-1177, to the committee. A copy of the Division of Insurance report is appended as Attachment A.
Mr. Dean provided the committee with some background regarding how the evaluation came about. Colorado law, Section 10-16-709, C.R.S., enacted in 1997 by HB 97-1122, has been challenged by an insurer. The law reads:
When a covered person receives services or treatment in accordance with plan provisions at a network facility, the benefit level for all covered services and treatment received through the facility shall be the in-network benefit.
The Division of Insurance has interpreted the law to hold a consumer harmless for charges other than in-network co-pays (and coinsurance) for all covered health care services received at a particular facility if the facility is in the consumer's plan network. Insurers argue that this interpretation has created a disincentive for health care providers to contract with health care plans because providers see they can receive payment for full-billed charges, rather than a lower negotiated plan reimbursement rate.
The Division of Insurance was required to hold public hearings on the issue and report to the Joint Business Affairs and Labor Committees by February 1, 2005. The Commissioner was to report what rules, if any, have been promulgated by the various agencies. If no rules were promulgated, the Commissioner was to report the reasons why. The Commissioner's report lists the issues involved, reports the results of the public hearings, makes suggestions to the General Assembly regarding policy options, and summarizes the regulatory responses from the Division of Insurance, the Division of Registrations, and the Department of Public Health and Environment.