To amend section 3901.386 of the Revised Code to require insurers and other third-party payers to accept and honor assignment-of-benefit agreements entered into between plan beneficiaries and treating health care providers.

Section 1. That section 3901.386 of the Revised Code be amended to read as follows:

Sec. 3901.386. (A) Notwithstanding section 1751.13 or division (I)(2) of section 3923.04 of the Revised Code, a reimbursement contract entered into or renewed on or after June 29, 1988, between a third-party payer and a hospital shall provide that reimbursement for any service provided by a hospital pursuant to a reimbursement contract and covered under a benefits contract shall be made directly to the hospital.

(B) If the a third-party payer and the hospital a provider have not entered into a contract regarding the provision and reimbursement of covered services, the third-party payer shall accept and honor a completed and validly executed assignment of benefits with a hospital provider by a beneficiary, except when the third-party payer has notified the hospital in writing of the conditions under which the third-party payer will not accept and honor an assignment of benefits. Such notice shall be made annually.

(C) A third-party payer may not refuse to accept and honor a validly executed assignment of benefits with a hospital pursuant to division (B) of this section for medically necessary hospital services provided on an emergency basis

A claim under a benefits contract is not settled until the provider receives payment for those health care services rendered to a beneficiary that are covered under a benefits contract. Both a beneficiary executing an assignment of benefits with a provider and a third-party payer accepting the assignment of benefits are liable for the amount due to the provider.

When a valid assignment-of-benefits agreement is executed, a health care provider shall not bill the beneficiary more than the difference between eighty per cent of the health care provider's total billed charges and the amount paid to the provider directly by the third party payer except when emergency services are provided.

(D) As used in this section:

(1) "Emergency services" means health care services rendered by any of the following:

(a) A physician, physician group, physician partnership, or physician professional corporation who provides health care services in a hospital emergency department;

(b) An ambulance or other vehicle that provides emergency medical services, as defined in division (G) of section 4765.01 of the Revised Code, in response to a call placed to a 9-1-1 system, as defined in section 4931.40 of the Revised Code;

(c) An air medical service organization providing air medical transportation and is otherwise engaged in providing emergency medical services to the public with a rotorcraft air ambulance or fixed wing air ambulance.

(2) "Patient" means any individual who as a result of illness or injury needs medical attention, whose physical or mental condition is such that there is imminent danger of loss of life or significant health impairment, or who may be otherwise incapacitated or helpless as a result of a physical or mental condition.

(3) "Provider" means a hospital, long-term care facility, nursing home, physician, podiatrist, dentist, pharmacist, chiropractor, or other licensed health care provider, provider partnership, or provider professional corporation. "Provider" also includes any person licensed or otherwise authorized to transport patients, including but not limited to emergency victims, to, from, or between providers.

(4) "Third-party payer" means a sickness and accident insurer, health insuring corporation, intermediary organization as defined in section 1751.01 of the Revised Code, or any other person obligated pursuant to a benefits contract to reimburse for covered health care services rendered to beneficiaries, up to the limits and exclusions contained in the benefits contract.

Section 2. That existing section 3901.386 of the Revised Code is hereby repealed.