Ohio Department of Insurance Adds Toolkit to Help with New Surprise Billing Rule

It’s been a little over a month since the Ohio Department of Insurance Surprise Billing rule became effective, and the department has now added an online Toolkit to help consumers, providers and stakeholders. The Toolkit is available here.

The new rule prohibits out-of-network facilities and ambulances (OON Providers) from balance-billing patients for certain services. The Ohio law adds an additional layer of regulatory complexity on top of the Federal No Surprises Act regulations, which also became effective on Jan. 1, 2022.

While the regulations are largely similar, there are differences between them, including how reimbursement rates to OON providers are determined, applicability to ambulance services and applicability to types of health plans – fully or self-insured. The Ohio rule establishes a methodology for health plans to establish the rate to be paid to OON providers as well as processes for OON providers to negotiate or arbitrate reimbursement rates.

It is important that Ohio providers understand the Ohio-specific rule, as the Federal No Surprises Act regulations are intended to supplement rather than supplant state-specific laws.

If you have questions or would like assistance from experienced attorneys developing a strategy to handle the Ohio Surprise Billing rule or the Federal No Surprises Act, please contact Kelly Leahy, Tim Cahill, Joe Wheeler, or another Dinsmore health care attorney.