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New Hampshire Insurance Department Implements New Protections Against Balance Billing and State Dispute Resolution Process
CONCORD, NH (January 13, 2025) – The New Hampshire Insurance Department announces significant updates to state laws aimed at protecting consumers from balance billing and enhancing the dispute resolution process. These changes, enacted through SB 173 during the 2024 legislative session, took effect on January 1, 2025.
The updated laws strengthen protections under both state law and the federal “No Surprises Act,” ensuring that consumers are not burdened with unexpected out-of-network charges in emergency care or at in-network facilities. Under the new framework, out-of-network providers and facilities are required to negotiate directly with health insurance carriers and initiate a dispute resolution process when necessary.
Previously, the state’s dispute resolution process applied to specific services such as anesthesiology, radiology, emergency medicine, and pathology, with federal processes covering all other situations. The revised state law now allows providers and facilities the flexibility to choose between state and federal dispute resolution processes for eligible disputes.
“The implementation of these changes represents a significant step forward in protecting New Hampshire consumers from unexpected medical expenses,” said Insurance Commissioner DJ Bettencourt. “By providing a streamlined and efficient state dispute resolution process, we are ensuring that healthcare billing disputes are resolved fairly and effectively.”
The new state dispute resolution process closely mirrors the federal system while addressing inefficiencies that have impacted the federal process. Providers and facilities can initiate the state process using newly developed forms available on the New Hampshire Insurance Department’s website. Additional technical guidance will be provided as the department finalizes its rulemaking process.
The updates also clarify how consumer cost-sharing amounts are calculated when care is provided by out-of-network providers for emergency services or at in-network facilities. Cost-sharing will now be determined using the Qualified Payment Amount (QPA) or, in certain instances, the lesser of the billed amount or allowed amount.
Self-funded health plans, which are not automatically subject to the new law, have the option to voluntarily opt into the state dispute resolution process. A list of participating self-funded health plans will be maintained on the New Hampshire Insurance Department’s website.
“These updates not only enhance consumer safeguards but also ensure clarity and fairness for providers, carriers, and health plans navigating the resolution process,” said Deputy Insurance Commissioner Keith Nyhan. “The NHID is committed to maintaining transparency and consumer protections for Granite Staters.”
Consumers and stakeholders seeking additional information are encouraged to contact the New Hampshire Insurance Department Consumer Services by email or by telephone at 603-271-2261.
For more details on the new rules and forms, visit the New Hampshire Insurance Department website.
The full bulletin (Docket #INS 25-004-AB) can be viewed here.
The New Hampshire Insurance Department Can Help
The New Hampshire Insurance Department’s mission is to promote and protect the public good by ensuring the existence of a safe and competitive insurance marketplace through the development and enforcement of the insurance laws of the State of New Hampshire. Contact us with any questions or concerns you may have regarding your insurance coverage at 1‐800‐852‐ 3416 or (603) 271‐2261, or by email. For more information, visit https://insurance.nh.gov/.