Patients Deserve Price Tags Act

This bill amends the Public Health Service Act to strengthen price transparency requirements for hospitals, clinical diagnostic laboratories, imaging service providers, ambulatory surgical centers, and health plans, and to increase group health plan access to health data and oversight of administrative service providers.

Sec. 2, Strengthening hospital price transparency: This section adds a new section 2718A to the Public Health Service Act, which defines terms like 'applicable imaging service provider', 'applicable laboratory', and 'discounted cash price' (the minimum cash price a provider accepts, excluding charity care or third-party assistance).

Sec. 3, Clinical diagnostic laboratory price transparency: Starting January 1 of the year after one year from enactment, applicable laboratories must quarterly publish standard charges for each clinical diagnostic test, including a plain language description with billing codes, gross charge, discounted cash price, and payer-specific negotiated charges, along with ownership information.

Sec. 4, Imaging services price transparency: Starting January 1 of the year after one year from enactment, applicable imaging service providers must quarterly publish standard charges for each imaging service, including a plain language description with billing codes, gross charge, discounted cash price, and payer-specific negotiated charges, along with ownership information.

Sec. 5, Ambulatory surgical center price transparency: Starting January 1 of the year after one year from enactment, specified ambulatory surgical centers must quarterly publish standard charges for each service, including a plain language description with billing codes, gross charge, discounted cash price, and payer-specific negotiated charges, along with ownership information.

Sec. 6, Strengthening health coverage transparency requirements: This section amends section 2715A to require group health plans and insurers to provide enrollees, at enrollment, with the in-network rate, out-of-network allowed amount, cost-sharing liability, and accumulated deductible or out-of-pocket maximum amounts.

Sec. 7, Increasing group health plan access to health data: This section requires that contracts between group health plans and covered service providers (like providers, third-party administrators, or pharmacy benefit managers) allow the plan fiduciary access to all claims and encounter data, and supporting documentation, within 15 days of a request, and not unreasonably limit such access.

Sec. 8, Oversight of administrative service providers: For plan years starting after one year from enactment, agreements between group health plans or insurers and health plan service providers must not limit disclosure of information; such providers must quarterly provide to the plan or insurer, at no cost, information including calculation methodologies, pricing schedules, and reimbursement formulas.

Sec. 9, State preemption only in event of conflict: The bill's provisions do not supersede state law on health care price transparency unless the state law prevents application of the bill's requirements; this does not affect ERISA group health plans.

Sec. 10, Requirement for explanation of benefits: This section amends the advanced explanation of benefits to require a good faith estimate of the plan's payment amount with plain language descriptions and billing codes, and a notification that the recipient may be held harmless if the estimate does not match the billed amount; for plan years after implementation, participants are held harmless for substantially excess charges unless due to unforeseen circumstances.

Sec. 11, Transparency in billing: Health care providers requesting payment must include a notice of the individual's right to an itemized bill, with a phone number and website, language-assistance information, and charity care policies; providers cannot bill or take collections actions unless they comply with this notice or if the billed amount exceeds the disclosed price transparency amount, unless additional items were medically necessary due to unforeseen circumstances.

Sec. 12, Technical amendments: This section amends ERISA and the Internal Revenue Code to incorporate parts D and E of the Public Health Service Act as amended by this bill.

Sec. 13, Implementation and enforcement funding: Authorizes necessary sums for fiscal year 2026 and each subsequent fiscal year for the Secretary of Labor and the Secretary of Health and Human Services to carry out and enforce this Act.