This bill strengthens enforcement of existing balance billing protections by significantly increasing financial penalties on health plans and insurance companies that violate these rules. Currently, violations result in penalties of $100 per failure, but the bill raises penalties to $10,000 per violation for specific balance billing requirements related to emergency services, non-emergency services, and air ambulance services. The legislation also adds a powerful new penalty for plans that fail to pay providers on time after a dispute resolution decision, requiring them to pay three times the difference between their initial payment and the correct out-of-network rate, plus interest. Additionally, the bill requires the federal government to provide detailed public reports to Congress every six months on the number of audits conducted, complaints received, penalties issued, and the most common violations, creating greater transparency and accountability. The bill affects all group health plans and health insurance issuers but ultimately benefits patients and healthcare providers by making it more costly for insurance companies to improperly deny out-of-network claims or delay payments.
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