Patients Deserve Price Tags Act

Key Points

• Hospitals, labs, imaging providers, and surgical centers would have to post their real prices online, including the discounted cash price and the rates negotiated with each insurer, updated quarterly and in a consumer-friendly format so people can compare.
• Insurers would have to give members a real-time online tool to look up what a service will cost them, how much of their deductible they have met, and whether prior authorization or step therapy rules apply.
• The bill bans gag clauses in contracts that stop employers and plan sponsors from seeing the claims and pricing data on what they actually pay for healthcare, backed by penalties up to $100,000 per day for service providers that block access.
• Patients would receive an advance explanation of benefits estimating their total bill, and would generally be held harmless for charges that come in substantially higher than the estimate unless unforeseen medical needs arose.
• Providers must give patients an itemized bill on request within 30 days, at no cost, in plain language with billing codes, and cannot pursue collections if the bill exceeds the price they disclosed unless they document unforeseen complications.
• Non-compliant hospitals face civil penalties scaled by bed count, up to $10 million for persistent large-hospital violations, and cannot receive waivers except where full penalties would disrupt patient care.