Congressman Nick Langworthy is aiming to increase transparency throughout the nation's health care system. On Wednesday, Langworthy introduced the Clear Healthcare Expense Cost Knowledge (CHECK) Act, which would give employers greater visibility into health care spending, provide patients with clearer insurance information, and require providers to furnish detailed itemized medical bills before seeking payment.
Langworthy says, "Americans deserve greater transparency and information about their healthcare costs so they can make informed decisions about their care. The CHECK Act shines a light on the hidden costs and middlemen driving up health care expenses, gives patients clear and understandable information about their services, and helps protect families from surprise charges. Greater transparency means greater accountability, and that's exactly what this legislation delivers."
Among its key provisions, the CHECK Act would do the following:
- Require PBMs, TPAs, provider networks, and other healthcare service providers to disclose detailed claims, reimbursement, pricing, fee, rebate, and payment information to health plans on a quarterly basis.
- Prohibit contractual "gag clauses" that prevent employers and health plans from accessing information about healthcare spending.
- Require health plans and insurers to provide patients with detailed Explanations of Benefits within 45 days of receiving a claim, including plain-language descriptions of services, billing codes, insurance payments, patient cost-sharing obligations, and deductible information.
- Require health care providers and facilities to furnish patients with itemized medical bills before seeking payment or initiating collections actions.
- Protect patients from charges that exceed previously disclosed estimates unless providers can demonstrate medically necessary unforeseen circumstances or patient-requested changes in services.
- Establish meaningful penalties for health care middlemen and providers that fail to comply with transparency requirements.
Langworthy says the legislation applies to both ERISA-regulated health plans and self-funded, non-federal governmental health plans, ensuring broad transparency protections across the health care marketplace.
