SB26-017 • 2026

Out-of-Network Health Insurance Dispute Resolution

The bill makes changes to the dispute resolution process between health insurance carriers (carriers) and out-of-network health-care providers (providers) by: Mandating that a carrier provide a remitt

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Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor: Sen. S. Bright, Sen. L. Daugherty
Last action: 2026-01-29
Official status: Senate Committee on Health & Human Services Refer Amended to Appropriations
Effective date: Not listed

Plain English Breakdown

The official source material does not provide specific details about the enforcement of penalties or the extent of fines imposed by the Division of Insurance.

Health Insurance Dispute Resolution for Out-of-Network Providers

This bill changes how health insurance companies and out-of-network healthcare providers resolve disputes by requiring carriers to provide remittance advice, establish penalties for improper reimbursement, require annual reporting of patient use of out-of-network providers, and mandate the Division of Insurance to produce an annual report.

What This Bill Does

Requires health insurance carriers to provide a remittance advice with each payment made to an out-of-network provider.
Establishes penalties that the division of insurance may assess against a carrier for failing to properly reimburse a provider for services provided to a patient.
Requires carriers to annually submit information about patient use of out-of-network providers to the Division of Insurance.
Requires the Division of Insurance to produce an annual report on patient use of out-of-network providers and relevant arbitration data.

Who It Names or Affects

Health insurance carriers
Out-of-network healthcare providers

Terms To Know

Remittance advice: A document sent by a health insurance carrier to an out-of-network provider that explains the payment made for services provided.
Division of Insurance: The state agency responsible for regulating and overseeing insurance companies, including health insurance carriers.

Limits and Unknowns

It is unclear how penalties will be enforced or the extent of fines that can be imposed by the Division of Insurance.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

L.002

SEN Health & Human Services

Passed [*]

Plain English: The amendment modifies specific sections of the bill related to health insurance dispute resolution by removing certain subsections and making minor textual changes.

Removes lines from page 2, altering a section's wording.
Strikes out references to subsections (14) and (16) on page 3.
Adds the word 'AND' after 'LAW;' on page 4.
Eliminates specific text related to noncompliance on pages 4 and 5.

The amendment's technical nature makes it difficult to fully explain without context from the original bill sections being modified.

L.003

SEN Health & Human Services

Passed [*]

Plain English: The amendment adds a provision to protect data submitted by health insurance carriers as proprietary, a trade secret, and confidential.

Adds language that any data provided by an insurance carrier under this section is considered proprietary, a trade secret, and confidential.

The amendment does not specify what types of data are covered or how the confidentiality will be enforced.

L.004

SEN Health & Human Services

Passed [*]

Plain English: The amendment changes the bill to focus on how smaller reimbursement amounts for out-of-network health-care providers are disputed and how arbitration costs can be too high compared to the amount of underpaid claims, especially affecting smaller provider groups.

Adds language that highlights disputes involving smaller reimbursement amounts for certain providers.
Includes a new clause explaining that arbitration costs often exceed the value of underpaid claims, which disproportionately affects smaller provider groups.

The amendment text is limited and does not provide full details on how these issues will be addressed or resolved.

L.005

SEN Health & Human Services

Passed [*]

Plain English: The amendment changes the word 'WHEN' for certain instances of 'WHETHER' and adjusts some phrases related to payment conditions in the bill.

Replaces 'WHETHER' with 'WHEN' at specific locations on pages 4 and 5.
Removes 'LAW OR FEDERAL LAW;' and replaces it with 'LAW;'.
Modifies a phrase to include conditions under which payment was made, replacing 'OR THE' with a longer explanation.

The amendment text does not provide context for why these changes are being made, so the full implications of these edits are unclear.

L.006

SEN Health & Human Services

Passed [*]

Plain English: The amendment changes the reference to a specific section of law and removes some text from the bill.

Removes references to '10-16-106.5; AND' on page 5, line 15.
Strikes out lines 16 through 18 on page 5.

The amendment text does not provide enough information about the content of the removed lines or what specific changes this will make to the dispute resolution process between health insurance carriers and out-of-network providers.

L.007

SEN Health & Human Services

Passed [*]

Plain English: The amendment changes the dispute resolution process between health insurance companies and out-of-network healthcare providers by adding a new requirement for carriers to disclose when a patient's health benefit plan is governed by state law.

Adds 'AND' after 'UNDERPAYMENT;' on page 3, line 13 of the bill.
Inserts a new section (E) that requires carriers to disclose whether a patient's health benefit plan is governed by state law.

The amendment text does not provide details about how this disclosure will be implemented or what happens if the carrier fails to comply with this requirement.

Bill History

2026-01-29 Senate
Senate Committee on Health & Human Services Refer Amended to Appropriations
2026-01-14 Senate
Introduced In Senate - Assigned to Health & Human Services

Official Summary Text

The bill makes changes to the dispute resolution process between health insurance carriers (carriers) and out-of-network health-care providers (providers) by:
Mandating that a carrier provide a remittance advice with each payment made to a provider;
Establishing penalties that the division of insurance (division) may assess against a carrier that fails to properly reimburse a provider for services provided to a patient;
Requiring a carrier to annually submit information to the division concerning patient use of out-of-network providers; and
Requiring the division to produce an annual report regarding patient use of out-of-network providers and relevant arbitration data and statistics.
(Note: This summary applies to this bill as introduced.)

Current Bill Text

Read the full stored bill text

Second Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
INTRODUCED

LLS NO. 26-0124.02 Renee Leone x2695 SENATE BILL 26-017
Senate Committees House Committees
Health & Human Services
A BILL FOR AN ACT
CONCERNING CHANGES TO OUT-OF-NETWORK HEALTH-CARE SERVICES101
DISPUTE RESOLUTION PROCESSES FOR HEALTH INSURANCE102
CARRIERS.103
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov.)
The bill makes changes to the dispute resolution process between
health insurance carriers (carriers) and out-of-network health-care
providers (providers) by:
! Mandating that a carrier provide a remittance advice with
each payment made to a provider;
SENATE SPONSORSHIP
Daugherty and Bright,
HOUSE SPONSORSHIP
(None),
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law.
! Establishing penalties that the division of insurance
(division) may assess against a carrier that fails to properly
reimburse a provider for services provided to a patient;
! Requiring a carrier to annually submit information to the
division concerning patient use of out-of-network
providers; and
! Requiring the division to produce an annual report
regarding patient use of out-of-network providers and
relevant arbitration data and statistics.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, 10-16-704, amend2
(13); and recreate and reenact, with amendments, (14) and (16) as3
follows:4
10-16-704. Network adequacy - required disclosures - balance5
billing - rules - legislative declaration - definitions.6
(13) (a) (I) THE GENERAL ASSEMBLY FINDS AND DECLARES THAT:7
(A) U NDER CURRENT STATE LAW , PROVIDERS RESOLVE8
OUT-OF-NETWORK REIMBURSEMENT DISPUTES THROUGH AN INDIVIDUAL,9
CLAIM-BY-CLAIM ARBITRATION PROCESS THAT IS PROHIBITIVELY10
EXPENSIVE AND ADMINISTRATIVELY BURDENSOME;11
(B) T HE CURRENT FRAGMENTED PROCESS CREATES DE FACTO12
IMMUNITY FOR CARRIERS TO SYSTEMICALLY UNDERPAY CLAIMS BECAUSE13
THE COST OF A SINGLE ARBITRATION OFTEN EXCEEDS THE AMOUNT OF THE14
DISPUTED REIMBURSEMENT , WHICH PRACTICE PARTICULARLY IMPACTS15
SMALLER PROVIDER GROUPS;16
(C) THE DIVISION HAS AN ESTABLISHED COMPLAINT PROCESS THAT17
ALLOWS PROVIDERS TO SUBMIT COMPLAINTS TO ENSURE THAT PAYMENT18
REQUIREMENTS ARE MET BY CARRIERS . THIS ESTABLISHED COMPLAINT19
PROCESS REQUIRES THE RESOLUTION OF CLAIMS WITHIN THIRTY DAYS20
SB26-017-2-
AFTER THE COMPLAINT CONTAINING THE CLAIMS HAS BEEN FILED IF THERE1
ARE ONE HUNDRED OR FEWER CLAIMS SUBMITTED ON THE COMPLAINT2
FORM AND ALLOWS FOR ADDITIONAL TIME WHEN THERE ARE MORE THAN3
ONE HUNDRED CLAIMS SUBMITTED ON THE COMPLAINT FORM. HOWEVER,4
THE COMPLAINT PROCESS DOES NOT ENSURE PROMPT PAYMENT TO5
PROVIDERS OF MONEY OWED WHEN CARRIERS ARE DEEMED TO HAVE6
VIOLATED PAYMENT REQUIREMENTS.7
(D) TO IMPROVE FAIRNESS IN THE HEALTH-INSURANCE MARKET,8
THE DIVISION'S EXISTING OVERSIGHT AND ENFORCEMENT AUTHORITY OF9
CARRIER PAYMENTS TO PROVIDERS SHOULD BE AUGMENTED TO COMPEL10
PROMPT PAYMENT FROM CARRIERS WHEN UNDERPAYMENT IS IDENTIFIED11
IN THE COMPLAINT PROCESS , THEREBY PROVIDING A MORE EFFECTIVE12
PATHWAY FOR PROVIDERS TO CHALLENGE UNDERPAYMENT;13
(E) E FFECTIVE DISPUTE RESOLUTION IS FURTHER HINDERED14
BECAUSE CARRIERS FREQUENTLY FAIL TO DISCLOSE WHETHER A PATIENT'S15
HEALTH BENEFIT PLAN IS GOVERNED BY STATE LAW OR THE "EMPLOYEE16
RETIREMENT INCOME SECURITY ACT OF 1974", 29 U.S.C. SEC. 1001 ET17
SEQ., LEAVING PROVIDERS UNABLE TO DETERMINE IN WHICH JURISDICTION18
THE PROVIDER MAY APPEAL; AND19
(F) T HE DIVISION REQUIRES A CLEAR STATUTORY MANDATE TO20
COLLECT SPECIFIC REIMBURSEMENT METHODOLOGY DATA AND TO21
REINSTATE FORMAL REPORTING OF OUT -OF-NETWORK UTILIZATION IN22
ORDER TO ENSURE THAT THE TRANSPARENCY GOALS OF THIS SECTION ARE23
FULLY REALIZED.24
(II) T HE GENERAL ASSEMBLY THEREFORE INTENDS FOR THIS25
SUBSECTION (13) AND SUBSECTIONS (14) AND (16) OF THIS SECTION TO:26
(A) S TREAMLINE OUT -OF-NETWORK DISPUTE RESOLUTIONS BY27
SB26-017-3-
GRANTING THE DIVISION ADDITIONAL ENFORCEMENT AUTHORITY WITHIN1
ITS OUT-OF-NETWORK COMPLAINT PROCESS, INCLUDING A REQUIREMENT2
TO COMPEL PROMPT PAYMENT FROM CARRIERS WHEN UNDERPAYMENT IS3
IDENTIFIED;4
(B) R EQUIRE JURISDICTIONAL TRANSPARENCY BY MANDATING5
THAT CARRIERS CLEARLY STATE ON A REMITTANCE ADVICE WHETHER A6
HEALTH BENEFIT PLAN IS REGULATED BY STATE LAW OR FEDERAL LAW;7
(C) E MPOWER DATA -DRIVEN ENFORCEMENT BY REQUIRING8
CARRIERS TO DISCLOSE THE SPECIFIC METHODOLOGIES USED TO9
DETERMINE OUT-OF-NETWORK REIMBURSEMENT AND BY GRANTING THE10
COMMISSIONER AUTHORITY TO ORDER CORRECTIVE PAYMENTS AND11
IMPOSE FINES FOR NONCOMPLIANCE; AND12
(D) R ESTORE PUBLIC ACCOUNTABILITY BY REINSTATING THE13
REQUIREMENT THAT THE DIVISION PUBLISH AN ANNUAL REPORT ON THE14
IMPLEMENTATION AND IMPACT OF THE STATE 'S OUT -OF-NETWORK15
PAYMENT LAWS.16
(a) (b) When a carrier makes a payment to a provider or a17
health-care f acility pursuant to subsection (3)(d) or (5.5)(b) of this18
section, the provider or the facility may request, and the commissioner19
shall collect, data from the carrier to evaluate the carrier's compliance in20
paying the highest rate required. The information requested may21
PROVIDED MUST include the methodology for determining the carrier's22
median in-network rate or AND reimbursement for each service in the23
same geographic area.24
(b) Repealed.25
(c) W HEN A CARRIER MAKES A PAYMENT TO A PROVIDER OR A26
HEALTH-CARE FACILITY PURSUANT TO SUBSECTION (3)(d) OR (5.5)(b) OF27
SB26-017-4-
THIS SECTION, THE CARRIER SHALL PROVIDE A REMITTANCE ADVICE THAT1
IDENTIFIES WHETHER THE HEALTH BENEFIT PLAN THE CARRIER IS MAKING2
THE PAYMENT PURSUANT TO IS REGULATED BY THE STATE OR THE3
FEDERAL GOVERNMENT.4
(d) I F THE COMMISSIONER FINDS , BASED ON THE INFORMATION5
PROVIDED BY THE CARRIER PURSUANT TO SUBSECTION (13)(b) OF THIS6
SECTION, THAT THE CARRIER DID NOT PROPERLY REIMBURSE A PROVIDER7
FOR SERVICES PROVIDED TO A COVERED PERSON WHO HAS A HEALTH8
BENEFIT PLAN ISSUED AND DELIVERED IN THE STATE PURSUANT TO9
SUBSECTION (3)(d) OR (5.5)(b) OF THIS SECTION , THE COMMISSIONER10
SHALL ORDER THE CARRIER TO PAY:11
(I) T HE PROVIDER IN COMPLIANCE WITH SUBSECTION (3)(d) OR12
(5.5)(b) OF THIS SECTION;13
(II) ANY ADDITIONAL AMOUNTS THAT MAY BE DUE UNDER SECTION14
10-16-106.5; AND15
(III) A FINE THAT THE COMMISSIONER ASSESSES AND IN AN16
AMOUNT THAT THE COMMISSIONER DEEMS APPROPRIATE BASED ON THE17
FACTS.18
(14) B EGINNING ON JANUARY 1, 2027, AND ON OR BEFORE19
JANUARY 1 OF EACH YEAR THEREAFTER , EACH CARRIER SHALL SUBMIT20
INFORMATION TO THE COMMISSIONER , IN A FORM AND MANNER21
DETERMINED BY THE COMMISSIONER , CONCERNING THE USE OF22
OUT-OF-NETWORK PROVIDERS AND HEALTH-CARE FACILITIES BY COVERED23
PERSONS AND THE IMPACT ON PREMIUM AFFORDABILITY FOR CONSUMERS.24
(16) N OTWITHSTANDING SECTION 24-1-136 (11)(a)(I), ON OR25
BEFORE JULY 1, 2027, AND ON OR BEFORE EACH JULY 1 THEREAFTER, THE26
COMMISSIONER SHALL PRODUCE A REPORT THAT THE COMMISSIONER27
SB26-017-5-
POSTS ON THE DIVISION 'S WEBSITE AND SUBMITS TO THE HEALTH AND1
HUMAN SERVICES COMMITTEE OF THE SENATE AND THE HEALTH AND2
HUMAN SERVICES COMMITTEE OF THE HOUSE OF REPRESENTATIVES , OR3
THEIR SUCCESSOR COMMITTEES. THE REPORT MUST SUMMARIZE:4
(a) T HE INFORMATION SUBMITTED TO THE COMMISSIONER5
PURSUANT TO SUBSECTION (14) OF THIS SECTION; AND6
(b) T HE NUMBER OF COMPLAINTS FILED IN THE PREVIOUS7
CALENDAR YEAR; THE NUMBER OF COMPLAINTS SETTLED , ARBITRATED,8
AND DISMISSED IN THE PREVIOUS CALENDAR YEAR ; AND A SUMMARY9
REFLECTING THE NUMBER OF COMPLAINTS RESOLVED IN FAVOR OF THE10
CARRIER OR IN FAVOR OF THE PROVIDER OR HEALTH-CARE FACILITY. THE11
REPORT SUBMITTED PURSUANT TO THIS SUBSECTION (16) MUST NOT12
INCLUDE ANY INFORMATION THAT SPECIFICALLY IDENTIFIES THE13
PROVIDER, HEALTH -CARE FACILITY , CARRIER , OR COVERED PERSON14
INVOLVED IN EACH DECISION.15
SECTION 2. Act subject to petition - effective date -16
applicability. (1) This act takes effect at 12:01 a.m. on the day following17
the expiration of the ninety-day period after final adjournment of the18
general assembly (August 12, 2026, if adjournment sine die is on May 13,19
2026); except that, if a referendum petition is filed pursuant to section 120
(3) of article V of the state constitution against this act or an item, section,21
or part of this act within such period, then the act, item, section, or part22
will not take effect unless approved by the people at the general election23
to be held in November 2026 and, in such case, will take effect on the24
date of the official declaration of the vote thereon by the governor.25
(2) This act applies to payments owed by health insurance carriers26
on or after the applicable effective date of this act.27
SB26-017-6-