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State: Wisconsin Law Would Make Medical Procedure Costs Public

by Astrid Fiano, DOTmed News Writer | May 19, 2010
This report originally appeared in the April 2010 issue of DOTmed Business News

The Wisconsin legislature has passed Assembly Bill 614 that would require health care providers to give consumers information regarding the providers' median billed charge for any health care service, medical procedure or diagnostic test. The information would be provided without cost and within a reasonable time upon request. The providers also would disclose charge information for the providers 25 presenting conditions for the most frequently provided services, as identified by the Department of Health Services (DHS). The Department would be allowed to directly assess forfeitures, including up to $500 for each violation of the act.

The disclosure requirements apply to health care facilities including hospitals, ambulatory surgical centers, nursing homes, and to health care provider associations. Health care providers would be required to display prominently statements informing health care consumers of their right to receive charge information from the health care providers and from their insurers. The Department of Health would prescribe the methods for a health care provider to calculate and present median billed charges.

In addition to health care providers, a self-insured health plan of the state, county or city, or an insurer of a health insurance policy, must provide to an insured/enrollee a good faith estimate of the median reimbursement that the insurer/self-insured health plan expects to pay for a specified health care service in the geographic region of care. The insurer or self-insured health plan must also provide to an insured/enrollee a good faith estimate of the insured's or enrollee's total out-of-pocket cost for the specified service. This information as well would be provided upon request and at no charge.