Health Care PRICE Transparency Act

Increased Pricing Clarity for Hospitals: Hospitals must provide a list of standard charges in plain language that includes the gross charge, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges (Section 2, a(1)). This allows individuals to understand the full spectrum of what a service might cost.

Improved Accessibility via Digital Tools: Hospitals are required to maintain an internet-based price estimator tool that is searchable and does not require a subscription, fee, or the submission of personal identifying information (Section 2, a(2)(B)(iii)). This makes it easier for consumers to find costs quickly and privately.

Better Comparison of Shoppable Services: The bill requires hospitals to disclose prices for at least 300 shoppable services (Section 2, a(2)(A)). This provides a wide range of information for consumers planning medical services in advance.

Enhanced Insurer Transparency: Insurers must disclose in-network provider rates, out-of-network allowed amounts, and historical net prices for prescription drugs (Section 2, b(1)). This helps consumers understand the actual costs involved in their coverage.

Real-Time Cost Estimates: The bill mandates that insurers provide internet-based tools that offer real-time, accurate responses regarding cost-sharing information (Section 2, b(2)(D)(i)). This allows people to know exactly what they will owe at the time they use the tool.

Improved Searchability and Proximity Matching: Digital tools must allow users to search for cost-sharing information and refine results based on geographic proximity to in-network providers (Section 2, b(2)(D)(i)). This helps consumers find affordable care near them.

Financial Penalties for Non-compliant Hospitals: Hospitals that fail to provide the required information and do not complete a corrective action plan may face civil monetary penalties of up to $300 per day (Section 2, a(4)). While intended as enforcement, these costs are a burden on the hospital's operations.

Potential Differences Between Estimates and Actual Costs: The bill includes a notice that the estimate of cost-sharing liability for a covered item or service may be different from the actual charges an individual receives at the point of care (Section 2, b(3)(C)(i)(v)(II)). This means consumers might still face unexpected costs despite the transparency efforts.

No Guarantee of Benefits: Insurers must provide a statement that an estimate of cost-sharing liability is not a guarantee that benefits will be provided for that specific item or service (Section 2, b(3)(C)(i)(v)(III)). This creates uncertainty for individuals relying on these estimates for planning.