2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 7 - CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS (§§ 10-16-701 — 10-16-710) › Section 10-16-709 - Evaluation - nonparticipating health-care providers - legislative declaration - rules

(1)
(a)
The general assembly hereby finds and determines that not all health-care providers contract with all health insurers and therefore not all are participating providers. Health-care providers who do not contract with a carrier are considered to be nonparticipating providers as to that carrier. In addition, not all health-care providers are aware of the terms of health insurance coverage for health-care services provided to a consumer insured through individual or group health-care coverage. Therefore, the general assembly determines that there is a need to inform insured consumers of the scope of health insurance coverage available to the consumer for the services of nonparticipating providers who render services in a participating facility and the extent of an insured consumer's responsibility when services are rendered to an insured by a nonparticipating provider.
(b)
The general assembly hereby declares that it is in the best interest of the residents of this state to provide administrative direction to health insurance carriers, health-care providers, and health facilities to provide timely notice to a consumer concerning when the person may or may not incur additional charges for covered health benefits received from health care providers.
(2)
The insurance commissioner shall, in collaboration with the division of professions and occupations within the department of regulatory agencies, the department of public health and environment, any other state agency, and any interested party, hold public hearings to determine the extent and source of the problem of a consumer being billed for an amount not paid by his or her health insurance as a result of a nonparticipating provider delivering health-care services in a participating facility. These hearings shall also include an evaluation of the following:
(a)
Payments to nonparticipating providers in participating facilities;
(b)
Methods to improve disclosure to consumers of individual and group health insurance;
(c)
When a person may be responsible for amounts in excess of the person's covered benefits from a nonparticipating provider;
(d)
What the carrier's responsibilities are for payment for health benefits covered under the person's health benefit plan; and
(e)
The appropriate appeals process for insurers and health-care providers to settle disputes.
(3)
The insurance commissioner, the department of public health and environment, and the division of professions and occupations, including, but not limited to, any
type 1
board under the supervision of the division of professions and occupations, may promulgate rules in accordance with the findings from the evaluation conducted pursuant to subsection (2) of this section.
(4)
On or before February 1, 2005, the insurance commissioner shall report the findings of the evaluation pursuant to subsection (2) of this section to the business affairs and labor committees of the house of representatives and the senate. The insurance commissioner shall include in the report a description of the rules promulgated pursuant to subsection (3) of this section. If a state agency did not promulgate rules pursuant to subsection (3) of this section, that state agency shall submit to the insurance commissioner, for inclusion in the commissioner's report to the business affairs and labor committees of the house of representatives and senate, the reasons why rules were not promulgated pursuant to subsection (3) of this section.
L. 2004: Entire section added, p. 965, § 4, effective May 21.