An Act To Require Estimates of Patient Costs in Any Plan of Care prior to Treatment

Sec. 1. 22 MRSA §1725  is enacted to read:

§ 1725.  Cost estimates of care

A health care provider shall provide a patient with a written cost estimate of a proposed health care procedure or course of treatment, including prescription medication, recommended for the patient and the amount of that cost that will be covered by the patient’s insurer or other 3rd-party payor. A cost estimate required by this section must include the provider’s reasons for recommending the specific procedure or course of treatment and, if there are other options for the procedure or course of treatment, inform the patient of those options and costs of those options. If a health care provider reports to a referring health care provider recommending a procedure or course of treatment for a referred patient, the reporting health care provider shall provide the referring health care provider a cost estimate pursuant to the provisions of this section. For purposes of this section, “health care provider” means a physician, health care practitioner, hospital, clinic, clinical laboratory, health care facility or other person or facility that provides health care services and is licensed or registered by the State.

summary

This bill requires a health care provider to provide to a person recommended for a health care procedure or course of treatment a cost estimate of the procedure or treatment, the provider’s reasons for the procedure or treatment, other options and their costs and the amount of the cost that will be paid for by the person’s insurer. This bill also requires a health care provider to provide a cost estimate to a referring provider on a recommended procedure or course of treatment for a referred patient.