HB 1245 -- Health Care Payments

Sponsor:  Wright

This bill modifies the "prompt pay" provisions of Section
376.383, RSMo, by requiring health insurers and similar entities
to forward to the enrollee and the person entitled to
reimbursement notices of denial to pay a claim and notices that
additional information is needed to process the claim.  Under
the bill's provisions, the notice of denial is considered a
final determination unless the enrollee files an appeal in
accordance with the terms of the enrollee's health care plan.
When an enrollee files an appeal, the insurer is required within
45 days to pay the claim or forward a notice of denial to pay
the claim.

In addition, the bill prohibits health care providers from
charging late fees or interest on a patient's unpaid balance
until 30 days following a final determination of the
individual's health care benefits.  A health care provider that
violates this provision is guilty of a class A misdemeanor.