Wenstrup, Larson introduce legislation to help patients access information, avoid surprise medical bills
Lead Summary
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WASHINGTON, D.C.—Today, Congressmen Brad Wenstrup, D.P.M. (R-OH) and John Larson (D-CT) introduced legislation to improve patient access to accurate, up-to-date information on what health care providers are in their health insurance company’s network.
“Far too often, patients and their families don’t have access to the most accurate information before making an important medical decision and end up getting left with an unexpected out-of-pocket bill,” said Congressman Wenstrup. “That’s why I’m proud to join Congressman Larson in introducing bipartisan legislation that empowers patients facing medical choices. Our bill ensures that patients have clear and up-to-date information about which doctors are in their health insurance network and establishes safeguards to ensure patients can access this information in a timely fashion.”
“Dealing with medical issues is stressful enough, patients and families shouldn’t have to worry about receiving surprise medical bills when seeking treatment. I’m proud to introduce this legislation today with Dr. Wenstrup to ensure patients have all the information they need to make informed decisions about providers. This legislation improves the accuracy and availability of provider directories from insurance companies. Nobody should be left with a surprise out-of-pocket bill. This legislation puts patients first,” said Congressman Larson.
H.R. 5807 Summary
H.R. 5807 would require health care insurers to establish a “Provider Directory” database containing a list of all health care providers and facilities that are in an insurance plan’s network. The directory would include relevant information, such as address, phone number, specialty, and the date on which that information was last updated or verified. The bill would also establish a verification process to ensure that the directory’s records remain up-to-date as well as a protocol for how quickly and in what manner insurance companies would have to respond to beneficiaries’ inquiries. Finally, H.R. 5807 would require providers to notify insurers when they are entering or exiting a network as well as when any material changes to directory information occur. Providers who fail to comply would be subject to a civil monetary penalty.
“Far too often, patients and their families don’t have access to the most accurate information before making an important medical decision and end up getting left with an unexpected out-of-pocket bill,” said Congressman Wenstrup. “That’s why I’m proud to join Congressman Larson in introducing bipartisan legislation that empowers patients facing medical choices. Our bill ensures that patients have clear and up-to-date information about which doctors are in their health insurance network and establishes safeguards to ensure patients can access this information in a timely fashion.”
“Dealing with medical issues is stressful enough, patients and families shouldn’t have to worry about receiving surprise medical bills when seeking treatment. I’m proud to introduce this legislation today with Dr. Wenstrup to ensure patients have all the information they need to make informed decisions about providers. This legislation improves the accuracy and availability of provider directories from insurance companies. Nobody should be left with a surprise out-of-pocket bill. This legislation puts patients first,” said Congressman Larson.
H.R. 5807 Summary
H.R. 5807 would require health care insurers to establish a “Provider Directory” database containing a list of all health care providers and facilities that are in an insurance plan’s network. The directory would include relevant information, such as address, phone number, specialty, and the date on which that information was last updated or verified. The bill would also establish a verification process to ensure that the directory’s records remain up-to-date as well as a protocol for how quickly and in what manner insurance companies would have to respond to beneficiaries’ inquiries. Finally, H.R. 5807 would require providers to notify insurers when they are entering or exiting a network as well as when any material changes to directory information occur. Providers who fail to comply would be subject to a civil monetary penalty.