An Act To Improve Access to Cost-effective Health Care Services
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4303, sub-§21 is enacted to read:
21. Access to low-cost services. If an enrollee elects to obtain a covered outpatient health care service from an out-of-network provider at a cost that is the same or less than the statewide average for the same covered health care service based on data reported on the publicly accessible health care costs website of the Maine Health Data Organization, the carrier shall allow the enrollee to obtain the service from the out-of-network provider at the provider's charge and apply the payments made for that health care service toward the enrollee's member cost sharing, deductible and out-of-pocket maximum as specified in the enrollee's health plan as if the health care services were provided by a network provider.
summary
This bill requires health insurance carriers to apply the amount paid for a health care service provided by an out-of-network provider toward the enrollee's member cost sharing as specified in the enrollee's health plan as if the health care services were provided by a network provider if the cost of the out-of-network service is the same or less than the statewide average payment for the same service based on data reported on the publicly accessible health care costs website of the Maine Health Data Organization.