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 

Surprise billing happens when a patient receives an unexpected balance bill after they receive care from an out-of-network provider or at an out-of-network facility, such as a hospital. It can happen for both emergency and non-emergency care. Typically, patients don’t know the provider or facility is out-of-network until they receive the bill.

Balance billing happens when a health care provider (a doctor, for example) bills a patient after the patient’s health insurance company has paid its share of the bill. The balance bill is for the difference between the provider’s charge and the price the insurance company set, after the patient has paid any copays, coinsurance, or deductibles.

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 APCD Reimbursement Datasets


For Carriers - Out of Network Data Reporting

Deadline for data reporting extended to March 15, 2022

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.

*Note: template revised 2.11.22 with edit regarding data collection on contracted ambulance service providers in tab D., cell E19


Out-of-Network Arbitration Program

Out-of-Network Arbitration Program Main Page 

Out-of-Network Arbitration Request Form [Fillable PDF]

Arbitration Decision and Reporting Form [Fillable PDF]

Apply to be Arbitrator for the Out-of-Network Arbitration Program - The Division is currently not accepting applications for additional arbitrators

List of Qualified Arbitrators and Fees for the Out-of-Network Payment Arbitration Program