Baldwin Bill Opens Up Negotiations

A bill authored by State Sen. Scott Baldwin (R-Noblesville) that would protect patient access to health care by mitigating delayed care and resolving payment disputes between insurers and health care providers unanimously passed the Senate on Feb. 26.

In 2021, the federal government passed the No Surprises Act, which established the lawful way to resolve reimbursement disputes through an independent dispute resolution process. However, this process has been flooded with a higher number of claims than what was initially anticipated.

To address the large number of claims submitted through the dispute resolution process, Senate Enrolled Act 189 would allow insurers to trigger a “good faith” conference with all parties if a provider submits 25 or more disputes within a 90 day period. This meeting would be used to negotiate a reimbursement agreement instead of pursuing a dispute resolution case, which would avoid a delay in needed medical care and lead to increased costs.

SEA 189 would also prohibit insurers from imposing administrative fees on health providers who provide care involving an out-of-network providers. If an insurer charges a fee for an out-of-network service, this violation would be treated as an unfair and deceptive act and be subject to penalties in existing law.

SEA 189 would ensure Indiana’s health care market is competitive by preventing health insurance companies from using their power to urge health care providers toward specific health insurance carriers,” Baldwin said. “I want to thank Rep. Barrett for agreeing to sponsor my bill and working with me to ensure Hoosiers can get access to health care and in a timely manner.”

When hospitals are faced with financial penalties from insurance companies, they are incentivized to scramble to find in-network care or postpone care until someone in-network is available. By removing the financial pressure from insurers, health care employers and firms would be allowed to staff cases based on availability, patient need and clinician expertise – not network status.

SEA 189 would also protect hospitals from being punished for unavoidable out-of-network clinician participation, and clinicians would be protected from being forced into network relationships with insurance carriers, which would help promote healthy competition in health care.

SEA 189 now heads to the governor for further consideration.

Baldwin (R-Noblesville) represents Senate District 20, which includes Noblesville, Carmel, Cicero and unincorporated areas of Hamilton County.