TO MODIFY PAYMENT OF BENEFITS FOR CERTAIN HEALTHCARE PROVIDERS UNDER A HEALTH BENEFIT PLAN.

Out-of-network payments go to providers, not patients

Arkansas insurers must pay providers directly for covered out-of-network hospital, nursing, medical, and surgical services. Patients no longer receive those claim payments themselves. The rule covers individual, group, and blanket health plans, including Arkansas Medicaid, ARHOME, and successor programs. Covered insurers also include HMOs and self-insured government or church plans. The law uses the federal definition of nonfederal government plans as of January 1, 2025—not an effective date. Excluded coverage includes dental-only, vision-only, disability income, credit, liability supplements, auto or homeowners medical payments, workers’ compensation, and health benefits under Arkansas constitutional provisions. Hospital-confinement-only, accident-only, specified-disease, and long-term-care-only plans are also excluded. Outside the mandatory rule, standard payments to insured people, beneficiaries, or estates remain available. When the contract allows, insured people can direct provider payments in writing. Insurers may also pay up to $1,000 to a blood or marriage relative entitled to the money when the insured or policy permits. The law does not specify changes to benefit amounts or patients’ share of costs.