Summary as we understand it:
Providers must publish their prices and cannot deviate from those prices unless the price represents a financial hardship to the patient in which case the provider can discount the price.
If this interpretation is correct, providers will have to charge all payers the same.
If a provider’s listed price is greater than what a payer pays, i.e, what the insurance policy pays, the difference is the responsibility of the patient – nothing new as this has always been the case (balance billing).
If this bill passes, it will mean the end of PPO’s as we know them today.
“We knew this was coming and I think there will end up being some negotiations on the final bill. It’s probably not a bad thing, if done properly. Transparency is OK. The issue is and will always be ‘what is your real fee’, and how do you convey it to the public?” – San Antonio Physician
“There is a senate bill not as strong as this one that we think will pass. Hospitals hate the house version and will fight it.” – Dallas Insurance Consultant