100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB4933

 

Introduced , by Rep. David A. Welter

 

SYNOPSIS AS INTRODUCED:
 
New Act
215 ILCS 5/355a.5 new

    Creates the Health Care Cost Estimate Act and amends the Illinois Insurance Code. Provides that prior to an admission, procedure, or service and upon request by a patient or prospective patient, a health care provider shall, within 2 working days, disclose the allowed amount or charge of the admission, procedure, or service. Provides that if the health care provider is unable to quote a specific amount in advance, the health care provider shall disclose the estimated maximum allowed amount or charge for the proposed admission, procedure, or service. Requires every company that issues, delivers, amends, or renews any individual or group policy of accident and health insurance to establish a toll-free telephone number and Internet website that enables consumers to request and obtain from the company, in real time, the estimated or maximum allowed amount or charge for a proposed admission, procedure, or service and the estimated amount the insured will be responsible to pay for a proposed admission, procedure, or service that is a covered benefit, based on the information available to the company at the time the request is made. Provides that if a patient or prospective patient is covered by a health insurance policy, a health care provider who participates as a network provider under the patient's or prospective patient's health insurance policy shall, upon request of the patient or prospective patient, provide, based on the information available to the health care provider at the time of the request, sufficient information regarding the proposed admission, procedure or service for the patient or prospective patient to use the applicable toll-free telephone number and Internet website of the provider of the health insurance policy.


LRB100 18945 SMS 34195 b

 

 

A BILL FOR

 

HB4933LRB100 18945 SMS 34195 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the Health
5Care Cost Estimate Act.
 
6    Section 5. Definitions. As used in this Act:
7    "Allowed amount" means the contractually agreed upon
8amount paid by a provider of a health insurance policy to a
9health care provider for health care services provided to an
10insured.
11    "Health care provider" means any licensed health care
12professional or public or private facility that provides, on an
13inpatient or outpatient basis, preventive, diagnostic,
14therapeutic, convalescent, rehabilitation, or mental health
15services.
 
16    Section 10. Advance disclosure of costs for an admission,
17service, or procedure.
18    (a) Prior to an admission, procedure, or service and upon
19request by a patient or prospective patient, a health care
20provider shall, within 2 working days, disclose the allowed
21amount or charge of the admission, procedure, or service,
22including the amount for any facility fees required. However,

 

 

HB4933- 2 -LRB100 18945 SMS 34195 b

1if a health care provider is unable to quote a specific amount
2in advance due to the health care provider's inability to
3predict the specific treatment or diagnostic code, the health
4care provider shall disclose the estimated maximum allowed
5amount or charge for a proposed admission, procedure, or
6service, including the amount for any facility fees required.
7    (b) If a patient or prospective patient is covered by a
8health insurance policy, a health care provider who
9participates as a network provider under the patient's or
10prospective patient's health insurance policy shall, upon
11request of the patient or prospective patient, provide, based
12on the information available to the health care provider at the
13time of the request, sufficient information regarding the
14proposed admission, procedure, or service for the patient or
15prospective patient to use the applicable toll-free telephone
16number and Internet website of the provider of the health
17insurance policy, as required under Section 355a.5 of the
18Illinois Insurance Code. A health care provider may assist a
19patient or prospective patient in using the toll-free number or
20Internet website of the provider of the health insurance
21policy.
 
22    Section 15. The Illinois Insurance Code is amended by
23adding Section 355a.5 as follows:
 
24    (215 ILCS 5/355a.5 new)

 

 

HB4933- 3 -LRB100 18945 SMS 34195 b

1    Sec. 355a.5. Website and telephone number for disclosing
2estimated or maximum allowed amounts for an admission, service,
3or procedure. Every company that issues, delivers, amends, or
4renews any individual or group policy of accident and health
5insurance shall establish a toll-free telephone number and
6Internet website that enables consumers to request and obtain
7from the company, in real time, the estimated or maximum
8allowed amount or charge for a proposed admission, procedure,
9or service and the estimated amount the insured will be
10responsible to pay for a proposed admission, procedure, or
11service that is a covered benefit, based on the information
12available to the company at the time the request is made,
13including any facility fee, copayment, deductible,
14coinsurance, or other out-of-pocket amount for any covered
15benefit.