SB 17: Out-of-Network Health Insurance Dispute Resolution - Colorado

Final Act → Signed Act · 4 edits · May 30, 2026

MODERATE

This bill amends Colorado's health insurance laws to address disputes over out-of-network billing. It declares that the current individual arbitration process is too costly and burdensome for smaller providers, aiming to streamline dispute resolution. The changes mandate greater transparency by requiring insurers to disclose specific methodologies for calculating out-of-network rates and to clearly state when a patient's plan is governed by state law. Additionally, the bill grants the state Division of Insurance enhanced enforcement authority to compel prompt payments when underpayments are identified through complaints.

Scope change

The bill expands the Division of Insurance's oversight authority over health insurance carriers regarding out-of-network payments and dispute resolution processes.

REQUIREMENT

Requires health insurance carriers to disclose the specific methodologies used to determine out-of-network reimbursement rates.

Mandates that carriers clearly identify on payment advice when a patient's health benefit plan is regulated by state law.

ENFORCEMENT

Strengthens the Division of Insurance's ability to compel prompt payment from carriers when underpayment is identified in the complaint process.

DEFINITION

Adds a legislative declaration stating that the current claim-by-claim arbitration process is prohibitively expensive and administratively burdensome for some providers.

Rerevised → Final Act · 4 edits · May 21, 2026

MODERATE

This bill transitions from a draft proposal to a final act, adding a note confirming it is ready for the Governor's signature. The substantive policy content remains focused on improving dispute resolution for out-of-network healthcare by requiring insurance carriers to disclose payment methodologies, identify state-regulated plans on bills, and provide median in-network rates. It also grants the insurance division authority to compel prompt payments and impose fines for non-compliance.

Scope change

The bill's scope remains unchanged; it applies to payments made by health insurance carriers on or after the effective date.

TECHNICAL

Added a formal note stating the bill is prepared for signatures and directs readers to legislative status sheets for the Governor's action.

Reorganized the bill text to remove draft annotations (like 'Rerevised' and 'Shading denotes HOUSE amendment') and standardize the layout for the final act version.

REQUIREMENT

Consolidated and clarified the requirements for carriers to disclose specific methodologies used to determine out-of-network reimbursement and to state on remittance advice when a plan is regulated by state law.

ENFORCEMENT

Confirmed the division's authority to compel prompt payments and impose fines when carriers are found to have violated payment requirements under the new complaint process.

Revised → Rerevised · 5 edits · May 7, 2026

MODERATE

The bill was updated from 'Revised' to 'Rerevised' status, indicating it has incorporated all amendments adopted in the Second House. Additionally, new sponsors were added to the House sponsorship list, and the bill was marked as '3rd Reading Unamended' for the House, with a specific date of May 7, 2026. Substantive text changes include the removal of a requirement for carriers to submit proprietary data regarding median in-network rates and the deletion of a repealed subsection, while adding new language regarding payment timelines starting January 1, 2027.

Scope change

The bill's scope regarding data submission requirements was narrowed by removing the mandate for carriers to provide proprietary trade secret data on median in-network rates.

TIMELINE

Added a new requirement effective January 1, 2027, concerning carrier payments to providers or health-care facilities.

REQUIREMENT

Removed the requirement for carriers to submit proprietary data on median in-network rates and reimbursement for services.

TECHNICAL

Deleted a repealed subsection (b) that was previously included in the bill text.

Added metadata indicating the bill is in '3rd Reading Unamended' status for the House with a date of May 7, 2026.

Added five new sponsors to the House sponsorship list: Bacon, Duran, Lieder, Lindsay, Rutinel, and Stewart K.

Reengrossed → Revised · 4 edits · May 6, 2026

MODERATE

The bill was renumbered and its title was updated to reflect a focus on dispute resolution processes rather than just out-of-network changes. The most significant policy change is the removal of a requirement for health carriers to provide specific remittance advice identifying when payments are made under certain subsections, effectively eliminating a reporting obligation that previously existed in the reengrossed version.

Scope change

The bill's scope was narrowed by removing specific reporting requirements for carriers regarding out-of-network payments, while the bill's title was broadened to explicitly include dispute resolution processes.

REQUIREMENT

The requirement for carriers to provide specific remittance advice identifying payments made under subsections (3)(d) or (5.5)(b) was removed.

The requirement for carriers to provide their median in-network reimbursement rate for out-of-network claims on each remittance advice was removed.

TECHNICAL

The bill was renumbered from SB 17 to SB 26-017, and the title was updated to explicitly mention dispute resolution processes.

Senate sponsorship was updated to include Gonzalez R. as a co-sponsor alongside Stewart R.

Engrossed → Reengrossed · 4 edits · Apr 30, 2026

MODERATE

The bill was reengrossed to include additional co-sponsors and updated the legislative summary to reflect these changes. Substantively, the bill was amended to clarify that providers are unable to determine the jurisdiction for appeals due to a lack of carrier disclosure, and it removed a requirement for carriers to publicly post median reimbursement rates, instead requiring them only to provide this rate on remittance advice.

Scope change

The bill's scope regarding co-sponsorship was expanded, and the specific requirements for carrier transparency regarding reimbursement rates were modified to be less burdensome.

ELIGIBILITY

Added five new co-sponsors to the Senate sponsorship list (Coleman, Cutter, Exum, Hinrichsen, Kipp, Marchman, Roberts, Snyder, Wallace).

REQUIREMENT

Amended the legislative intent to clarify that providers are unable to determine the jurisdiction for appeals because carriers are not required to disclose when a patient's plan is governed by state law.

Removed the requirement for carriers to publicly post their median in-network reimbursement rates for out-of-network claims.

Modified the carrier disclosure requirement so that carriers must only provide the median in-network reimbursement rate for out-of-network claims on each remittance advice, rather than posting it publicly.

Introduced → Engrossed · 4 edits · Apr 28, 2026

MODERATE

This bill was amended to clarify that the new jurisdictional transparency requirement only applies to health plans governed by state law, removing the previous ambiguity regarding federal plans. Additionally, the bill added a new requirement for carriers to publicly post their median in-network reimbursement rates and to include these rates on every remittance advice sent to providers. A significant technical change was made to protect the data carriers submit to the state, reclassifying it as a trade secret and confidential information.

Scope change

The scope of the jurisdictional transparency mandate was narrowed to exclude federal health plans, while the scope of data reporting requirements was expanded to include public posting of reimbursement rates.

REQUIREMENT

The requirement for carriers to disclose whether a plan is state or federal law was changed to only mandate disclosure for plans regulated by state law.

Carriers are now required to publicly post their median in-network reimbursement rates for out-of-network claims.

Carriers must include the median in-network reimbursement rate on every remittance advice sent to providers.

DEFINITION

Data submitted by carriers to the state regarding reimbursement methodologies is now explicitly defined as proprietary, a trade secret, and confidential.

Out-of-Network Health Insurance Dispute Resolution

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