What Ohio's 'Surprise Billing' Ban Means For Providers

April 19, 2022

What Ohio's 'Surprise Billing' Ban Means For Providers

Ohio's H.B. 388 prohibits certain out-of-network providers, facilities, emergency facilities and ambulances from balance billing patients for services. Dinsmore's Kelly Leahy, Tim Cahill and Joseph Wheeler wrote about it for Law360. An excerpt is below.

Out-of-network providers are now required to seek full reimbursement for their services from the patient's health plan. H.B. 388 created a required procedure to facilitate these payments to out-of-network providers.

Health plans are required to make an initial payment equal to the greatest of three amounts they are required to calculate. Out-of-network providers can either accept the payment as full reimbursement or initiate a negotiation and arbitration process.

The negotiation process is generally informal, excluding certain statutory deadlines, but the arbitration process requires the use of an arbitrator contracted by the Ohio Department of Insurance, and delineates the factors to be considered in the decision-making process.

Read the full article here, or click the download button above to view the PDF.