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SB 928 - This act specifies that necessity of emergency services to screen and stabilize a patient shall be determined by the treating physician. Before a health carrier retrospectively denies payment for an emergency service, a qualified physician shall review the enrollee's medical records regarding the emergency condition at issue. Carriers shall not deny payment based predominantly on current procedural terminology or International Classification of Diseases (ICD) codes. This act allows health carriers to recapture from enrollees payments made to health care providers for emergency services if it is determined the enrollee did not have an emergency condition. Payments shall be paid directly to the health care provider by the health carrier regardless of whether the provider participates in the carrier's network. The act prohibits carriers from reducing payments for evaluation and management services that are otherwise eligible for reimbursement when reported by the same provider on the same day as a procedure, and specifies that contract provisions to the contrary shall be void. The act specifies that payment for all services shall be made directly to providers when the carrier has authorized the patient to seek such services from a provider outside the carrier's network. ERIC VANDER WEERD
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