The Senate Committee on Health, Education, Labor and Pensions is asking Health and Human Services Secretary Robert F. Kennedy Jr. and other Trump administration officials to enforce the good-faith estimate provision of the No Surprises Act.
An Advanced Explanation of Benefits (AEOB) for upfront estimates of out-of-pocket costs remains an outstanding provision of the law, said U.S. Sens. Bill Cassidy, R-LA, Maggie Hassan, D-NH, and Roger Marshall, R-KS, in the July 25 letter to Kennedy, and the secretaries of the Departments of Labor and the Treasury.
The senators are urging action.
“When drafting this legislation, we continually heard from our constituents about not receiving an estimate of out-of-pocket costs before a scheduled medical service or procedure,” the letter said. “The No Surprises Act provided a solution: a requirement that providers, facilities, and payers give patients personalized estimates of their out-of-pocket expenses in advance of scheduled care.”
WHY THIS MATTERS
The concern is for patients who have private health insurance.
While the departments have implemented the good-faith estimate requirements for uninsured and self-pay patients, out-of-pocket cost AEOB estimates have not yet been fully implemented for patients with private health insurance, senators said.
Providers are required to provide the good-faith estimate to the individual’s health plan, which then must use that estimate to provide an advanced explanation of benefits directly to the enrollee, the letter said.
THE LARGER TREND
The letter comes after the Trump administration released an updated Hospital Price Transparency Rule proposal on July 15.
Also, a No Surprises Enforcement Act, introduced in the House in December 2024, proposes fining health insurance companies that fail to pay physicians within 30 days after losing the independent dispute resolution (IDR) process laid out in the No Surprises Act.
The American College of Radiology has said it supports the bill.
The No Surprises Act that went into effect on Jan. 1, 2022, aims to protect patients from surprise medical bills.
Email the writer: SMorse@himss.org