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Bill

HF 2434

A bill for an act relating to insurance coverage for health care services provided pursuant to a referral by an out-of-network primary care provider.

2025-2026 Regular Session

Bill requires insurers to cover out-of-network specialist referrals from out-of-network primary care doctors at in-network rates, protecting patients from unexpected bills.

Signed by Governor.
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WeVote Research Nonpartisan
Bill Summary · HF 2434

Legislative bill overview

HF 2434 requires insurance companies to cover health care services at in-network rates when a patient is referred to an out-of-network provider by their out-of-network primary care physician. This addresses a coverage gap where patients following their doctor's referral could face higher out-of-pocket costs despite receiving medically necessary care.

Why is this important

Patients currently risk substantial unexpected bills when referred out-of-network, which may deter them from seeking necessary specialist care or following physician recommendations. This bill aims to protect consumers from cost-shifting while maintaining continuity of care, particularly affecting those in areas with limited in-network specialist availability.

Potential points of contention

  • Insurance industry costs: Insurers may argue the mandate increases claims expenses and could lead to higher premiums or reduced out-of-network provider networks
  • Out-of-network provider incentives: The policy might discourage insurers from negotiating rates with specialists, potentially reducing their leverage to control healthcare costs
  • Primary care provider definition: Disputes may arise over which physicians qualify as "primary care providers" and what constitutes a valid "referral," creating administrative complexity

Compiled from official sources — confirm details with the bill’s official record.

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