Out-of-Network Health Care Provider Reimbursement

Federal "No Surprises" Act

The federal No Surprises Act will go into effect on January 1, 2022 and applies to self funded and fully insured plans. This new law will have some overlap with Colorado’s Out-of-Network Health Care Services law, put into place by HB19-1174. Know that the Division is working to evaluate the intersection between the state and federal laws. Both laws protect consumers from surprise out of network bills. If you receive a surprise bill and have questions about which law is applicable, contact our Consumer Services Division for assistance. 

303-894-7490 / 800-930-3745 (outside the Denver Metro area) / DORA_Insurance@state.co.us  
Monday - Friday, 8:00 a.m. - 5:00 p.m.

If you want to learn more about the federal No Surprises Act, please visit the No Surprises Act website (from the Center for Medicare & Medicaid Services) to see fact sheets on what No Surprises Act rules cover, as well as additional details about consumer protections.    

House Bill 19-1174 was passed by the Colorado Legislature to help protect patients from surprise out-of-network bills 

The bill includes provisions for how health insurance carriers will reimburse providers (doctors, hospitals and other health care providers) for out-of-network emergency and non-emergency care. 

Legislation and FAQ: HB19-1174 - Out-of-Network Health Care Services

Out-of-Network Health Care Provider Reimbursement Regulations

Out-of-Network APCD Reimbursement Datasets

For Carriers - Out of Network Data Reporting

Regulation 4-2-74 requires that all applicable health insurance carriers report data to the Commissioner of Insurance on the use of out-of-network providers and facilities, as well as the impact on premium affordability. To facilitate carrier submissions of these data the Division of Insurance has created a data reporting template. It is suggested that carriers download the template, fill it out, and email it to all of the following Division staff:

Out-of-Network Carrier Data Reporting Template

Frequently Asked Questions

Any questions about the data reporting template itself, reporting requirements, or issues reporting the required data by the deadlines listed in statute can be directed to the same Division staff listed above.