Out-of-Network Payment Arbitration Program

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An arbitration program for out-of-network provider and facility carrier reimbursement disputes

House Bill 19-1174 - Concerning out-of-network health care services provided to covered persons, established an arbitration program for out-of-network providers and out-of-network facilities who believe that the payment they received from a carrier was not sufficient given the complexity and circumstances of the services provided. The Division of Insurance (DOI) is tasked with managing the arbitration program.

Overview of the Arbitration Process

Non-Participating Provider Arbitration Request Form - Use this link to submit a request for arbitration, Division staff will follow-up with next steps.

Arbitration Decision and Reporting Form [Fillable PDF] - to be sent by the arbitrator to the health care provider / facility, insurance company and the Division of Insurance

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

Colorado Regulation 4-2-65 - Concerning the Establishment of a Carrier Payment Arbitration Program for Out-of-Network Providers

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

 

For questions about this program, please contact the Division of Insurance at dora_doi_arbitration@state.co.us

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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.