Amends TCA Section 56-7-120.

Present law provides the following concerning the assignment of benefits to healthcare providers:<br /> <br /> (1) If a policy of insurance issued in this state provides for coverage of health care rendered by a healthcare provider, then the insured or other persons entitled to benefits under the policy are entitled to assign their benefits to the healthcare provider and such rights must be stated clearly in the policy, and notice of the assignment must be in writing to the insurer in order to be effective unless otherwise stated in the policy;<br /> <br /> (2) However, an insured's assignment of benefits may be disregarded by an insurer if the assignment of benefits is to an out-of-network facility-based physician, and the following conditions are not satisfied:<br /> <br /> (A) The healthcare facility provides certain written notice to the insured, or the insured's personal representative, and<br /> <br /> (B) The insured, or the insured's personal representative, signs the written notice, acknowledging agreement to receive medical services by an out-of-network provider or should the insured or insured's personal representative refuse to sign the written notice, the healthcare facility documents in the patient's medical record that it provided the notice and that the patient refused to sign the notice;<br /> <br /> (3) The written notice described in (2) must be provided to the insured, or the insured's personal representative, prior to when the insured first receives services from the out-of-network facility-based physician. However, if the insured is receiving medical services through a hospital emergency department or is incapacitated or unconscious, then the written notice is not required until the insured is stabilized;<br /> <br /> (4) If the healthcare facility fails to provide the written notice described in (2), then such failure does not create a right of indemnification or private cause of action against the healthcare facility by an out-of-network facility-based physician for an insurer's disregard of an insured's assignment of benefits unless certain circumstances apply;<br /> <br /> (5) The provisions of (3) and (4) do not apply to accident-only, specified disease, hospital indemnity, medicare supplement, long-term care, or other limited benefit hospital insurance policies; and<br /> <br /> (6) An in-network healthcare facility does not need to provide an insured with the written notice described in (2) if:<br /> <br /> (A) The healthcare facility employs all facility-based physicians or requires all facility-based physicians to participate in all of the insurance networks in which the healthcare facility is a participating provider; or<br /> <br /> (B) The healthcare facility contractually prohibits all facility-based physicians from balance billing patients in excess of the cost sharing amount required in accordance with the insured's health benefits coverage for the items and services provided.<br /> <br /> This bill removes (2)-(6) from present law, thereby removing the ability of an insurer to disregard an insured's assignment of health benefits to an out-of-network facility-based physician.<br />