42 U.S.C. § 300gg–133 — Provider requirements with respect to disclosure on patient protections against balance billing

submitted 82 years ago by Pub. L. 116-260 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 251 words · no verdicts yet

in plain englishAI-generated · not legal advice

Every health care provider and facility must give patients a one-page notice, in plain language, explaining balance-billing protections. It must cover federal and state billing limits and how to complain if those rules are broken. This has applied since January 1, 2022.

Starting no later than January 1, 2022, every health care provider and health care facility must make public — and, if applicable, post on its own website — a one-page notice for patients covered by a group health plan or health insurance. It must send this notice by mail or email, whichever the patient prefers. Written in clear, understandable language, the notice must cover three things: the provider's or facility's obligations and restrictions under sections 300gg–131 and 300gg–132, which ban balance billing in certain circumstances; any other applicable state-law limits on what the provider or facility can charge a patient — after the plan has paid and any cost-sharing was collected — for care from a provider without a contract with the plan; and how to contact the right state and federal agencies if a patient believes the provider or facility violated either of these requirements.

the actual law source: uscode.house.gov ↗public domain

Beginning not later than January 1, 2022, each health care provider and health care facility shall make publicly available, and (if applicable) post on a public website of such provider or facility and provide to individuals who are participants, beneficiaries, or enrollees of a group health plan or group or individual health insurance coverage offered by a health insurance issuer a one-page notice (either postal or electronic mail, as specified by the participant, beneficiary, or enrollee) in clear and understandable language containing information on—

(1)

the requirements and prohibitions of such provider or facility under sections 300gg–131 and 300gg–132 of this title (relating to prohibitions on balance billing in certain circumstances);

(2)

any other applicable State law requirements on such provider or facility regarding the amounts such provider or facility may, with respect to an item or service, charge a participant, beneficiary, or enrollee of a group health plan or group or individual health insurance coverage offered by a health insurance issuer with respect to which such provider or facility does not have a contractual relationship for furnishing such item or service under the plan or coverage, respectively, after receiving payment from the plan or coverage, respectively, for such item or service and any applicable cost-sharing payment from such participant, beneficiary, or enrollee; and

(3)

information on contacting appropriate State and Federal agencies in the case that an individual believes that such provider or facility has violated any requirement described in paragraph (1) or (2) with respect to such individual.

Source credit: (July 1, 1944, ch. 373, title XXVII, § 2799B–3, as added Pub. L. 116–260, div. BB, title I, § 104(a), Dec. 27, 2020, 134 Stat. 2829.)

history & why it existsrecord from the source credit

1944Enacted · Pub. L. 116-260 · 134 Stat. 2829

A history note hasn’t been published yet. The record shows enactment by Pub. L. 116-260 on 1944-07-01.

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