Bill > S762

This bill aims to streamline and improve healthcare cost transparency by requiring healthcare providers to disclose specific cost and insurance participation information to patients before medical procedures. When scheduling a non-emergency admission, procedure, or service, healthcare providers must now inform patients whether they participate in the patient's health benefit plan. For providers participating in a patient's insurance plan, they must provide the insurance carrier with a good faith estimate of billing and diagnostic codes, and the insurance carrier must then inform the patient of their estimated out-of-pocket costs within 1-3 business days, depending on how far in advance the procedure is scheduled. For providers not participating in a patient's insurance plan or for uninsured patients, providers must give a detailed cost estimate, including facility fees, and inform patients about potentially lower-cost alternative providers. If a non-participating provider fails to provide the required notifications, they can only bill the patient for standard copayments, coinsurance, or deductibles. The bill also establishes enforcement mechanisms, allowing the commissioner to impose penalties up to $5,000 per violation for both healthcare providers and insurance carriers, with provisions to avoid duplicate penalties from other regulatory bodies.

Budget and Finance, Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S762