Fair and Honest Advance Cost Estimate for Patients Act of 2020

Fair and Honest Advance Cost Estimate for Patients Act of 2020

This bill requires health care providers and private health insurance plans to provide certain estimates for the costs of services that are scheduled three or more business days in advance. Specifically, providers must inquire whether an individual scheduling such service is enrolled in a health plan, including a government health care program, and intends to seek benefits for the service under the plan. Within a specified time period prior to administering such service, the provider must submit to the individual’s plan, or to the individual if the individual is not enrolled in a plan, an estimate of expected charges for the service. Providers are subject to a maximum fine of $10,000 for each failure to provide such an estimate.

Within a specified time period after receiving an estimate from a provider for a service, private health insurance plans must provide the plan holder with specified benefits information that includes but is not limited to

• the provider's estimated charge,
• whether the provider is in-network,
• the plan's estimated share of the amount,
• the plan holder's estimated cost-sharing amount, and
• the estimated amount remaining to meet the plan holder's deductible or out-of-pocket maximum.