Ohio Balance Billing Law

Overview

Ohio SB 198 (2020) provides balance billing protections for emergency services. Non-emergency services rely primarily on federal NSA standards. Ohio does not have a separate state-level balance billing statute for non-emergency OON services at in-network facilities. The Ohio Department of Insurance handles complaints and enforcement.

Key Requirements

1. Emergency services at any facility are protected from balance bills under SB 198.
2. Non-emergency OON services at in-network facilities are covered under federal NSA, not separate state law.
3. Patients must receive written notice of balance billing rights.
4. Patients may request insurer review of charges within 30 days of the bill.
5. Insurers must address patient complaints within 30 days.

Penalties and Enforcement

The Ohio Department of Insurance enforces SB 198 and federal NSA compliance. Violations result in fines and enforcement actions. Providers who balance bill for emergency services face penalties. Consumers can file complaints with OH DOI. Federal enforcement through CMS supplements state enforcement.

Appeals and Exceptions

Balance billing protections apply to emergencies (SB 198) and NSA-covered services. Elective out-of-network care and non-emergency services lacking NSA coverage are not protected. Federal NSA standards provide a safety net for many services.

Interaction with Federal Law

Federal NSA is the primary protection framework for many Ohio balance billing scenarios. SB 198 supplements NSA for emergencies. Ohio DOI coordinates with CMS on compliance. When federal and state law conflict, the more protective standard applies.

Common Questions