# What the Health Care PRICE Transparency Act Does

This bill is about making healthcare prices visible before you get care. Right now, hospitals and insurance companies keep their pricing information largely hidden, making it nearly impossible for patients to know what they'll actually pay for a procedure or service. This bill would require both hospitals and insurance companies to publicly disclose their prices in plain language, free of charge, and in easy-to-use online tools.

For hospitals specifically, the bill requires them to publish pricing information for at least 300 common medical services that can be scheduled in advance—things like X-rays, lab tests, or routine surgeries. Hospitals would have to show several different prices: the full "sticker price," what different insurance companies have negotiated to pay, the lowest and highest prices they've negotiated with any insurance company, and what uninsured patients would pay if they get a discount for paying cash. All this information must be searchable by service name and billing code, and accessible through an online price estimator tool on the hospital's website. If a hospital doesn't comply, it could face fines up to $300 per day until it fixes the problem.

For insurance companies, the bill requires them to provide similar transparency through online tools and paper forms. When you ask your insurance company what a specific service will cost you, they'd have to give you a real-time estimate that includes your personal cost-sharing (copays, deductibles, coinsurance), the negotiated rates they pay providers, and what out-of-network care might cost. The tool would let you compare costs across different providers in your area and see how much you've already spent toward your deductible. Insurance companies would also have to disclose the actual prices they negotiate for prescription drugs, including rebates and discounts they receive.

The practical effect is that patients would finally be able to shop around and compare prices before getting care, similar to how you'd compare prices for any other service. This could help people find more affordable options, avoid surprise bills, and make more informed decisions about their healthcare. However, the bill doesn't actually cap or control what hospitals and insurers can charge—it just requires them to tell you what those charges are upfront.

Health Care PRICE Transparency Act

Davidson, Warren

Health Care Prices Revealed and Information to Consumers Explained Transparency Act or the Health Care PRICE Transparency Act This bill provides statutory authority for requirements for hospitals and health insurance plans to disclose certain information about the costs for items and services. Specifically, hospitals must publish in their list of standard charges certain rates negotiated with insurers, discounts for cash payments, and billing codes. Further, hospitals generally must publish the standard charges for the services provided by the hospital that may be scheduled in advance. Additionally, insurance plans must publish the in-network and out-of-network charges for covered items and services and the negotiated prices for covered prescription drugs. Plans must provide a tool for consumers to search for this cost information. Consumers also may request additional information about the costs of specific items or services under their plans.