42 U.S.C. § 300gg–136 — Provision of information upon request and for scheduled appointments

submitted 82 years ago by Pub. L. 116-260 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 315 words · no verdicts yet

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Health care providers must ask patients about insurance before scheduled visits. They must also give a good-faith written cost estimate with billing codes. This applies starting January 1, 2022, when visits are booked at least 3 business days ahead.

Starting January 1, 2022, this rule applies to every health care provider and every health care facility, whenever a patient schedules an item or service at least 3 business days before the day it will happen. Deadlines to act: - If the visit is booked at least 3 business days ahead, the provider or facility must act within 1 business day after the booking. - If the visit is booked at least 10 business days ahead — or if the patient asks sooner — the provider or facility must act within 3 business days after the booking or the request. By that deadline, the provider or facility must do two things: (1) Ask the patient whether they are enrolled in a group health plan, individual health insurance coverage, or a federal health care program — and if so, whether they want a claim for this item or service submitted to that plan or coverage. (2) Give a good-faith estimate, written in clear and understandable language, of the expected charges for the item or service. This estimate must also cover any other item or service that is reasonably expected to happen along with it, even one provided by a different health care provider or facility. The estimate must include the expected billing and diagnostic codes. The provider or facility must send this estimate to: (A) the patient's health plan or insurer — if the patient is enrolled in one and wants a claim filed there; or (B) the patient directly — if the patient is not described in (A) and is not enrolled in a federal health care program.

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

Each health care provider and health care facility shall, beginning January 1, 2022, in the case of an individual who schedules an item or service to be furnished to such individual by such provider or facility at least 3 business days before the date such item or service is to be so furnished, not later than 1 business day after the date of such scheduling (or, in the case of such an item or service scheduled at least 10 business days before the date such item or service is to be so furnished (or if requested by the individual), not later than 3 business days after the date of such scheduling or such request)—

(1)

inquire if such individual is enrolled in a group health plan, group or individual health insurance coverage offered by a health insurance issuer, or a Federal health care program (and if is so enrolled in such plan or coverage, seeking to have a claim for such item or service submitted to such plan or coverage); and

(2)

provide a notification (in clear and understandable language) of the good faith estimate of the expected charges for furnishing such item or service (including any item or service that is reasonably expected to be provided in conjunction with such scheduled item or service and such an item or service reasonably expected to be so provided by another health care provider or health care facility), with the expected billing and diagnostic codes for any such item or service, to—

(A)

in the case the individual is enrolled in such a plan or such coverage (and is seeking to have a claim for such item or service submitted to such plan or coverage), such plan or issuer of such coverage; and

(B)

in the case the individual is not described in subparagraph (A) and not enrolled in a Federal health care program, the individual.

Source credit: (July 1, 1944, ch. 373, title XXVII, § 2799B–6, as added Pub. L. 116–260, div. BB, title I, § 112, Dec. 27, 2020, 134 Stat. 2866.)

history & why it existsrecord from the source credit

1944Enacted · Pub. L. 116-260 · 134 Stat. 2866

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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