Cost Transparency: Physician Impact in 2016

On January 1, 2016, an important section of this year’s healthcare reform legislation takes effect. While most physicians currently do so for their patients, Public Act 15-146 will require physicians to provide certain information to patients for non-emergency care prior to services being provided. If you have questions or concerns about the implementation of this requirement, please contact CSMS SVP for Government Affairs Ken Ferrucci.

Sec. 3. (NEW) (Effective October 1, 2015) (a) On and after January 1, 2016, each health care provider shall, prior to any scheduled admission, procedure or service, for nonemergency care, determine whether the patient is covered under a health insurance policy. If the patient is determined not to have health insurance coverage or the patient's health care provider is out-of-network, such health care provider shall notify the patient, in writing, electronically or by mail, (1) of the charges for the admission, procedure or service, (2) that such patient may be charged, and is responsible for payment for unforeseen services that may arise out of the proposed admission, procedure or service, and (3) if the health care provider is out-of-network under the patient's health insurance policy, that the admission, service or procedure will likely be deemed out-of-network and that any out-of-network applicable rates under such policy may apply. Nothing in this subsection shall prevent a health care provider from charging a patient for such unforeseen services.

(b) Each health care provider and health carrier shall ensure that any notice, billing statement or explanation of benefits submitted to a patient or insured is written in language that is understandable to an average reader.