Chief Sponsor: Jacob L. Anderegg

House Sponsor: ____________


8     General Description:
9          This bill enacts provisions relating to health care costs.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     requires certain health care providers to provide a patient with an itemized estimate
14     of the cost of providing health care services before the patient receives the health
15     care services; and
16          ▸     prohibits a health care provider from billing a patient in certain circumstances.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     ENACTS:
23          58-1-509, Utah Code Annotated 1953

25     Be it enacted by the Legislature of the state of Utah:
26          Section 1. Section 58-1-509 is enacted to read:
27          58-1-509. Health care cost estimates -- Requirements -- Exceptions.

28          (1) As used in this section:
29          (a) "Enrollee" means the same as that term is defined in Section 31A-1-301.
30          (b) "Health benefit plan" means the same as that term is defined in Section 31A-1-301.
31          (c) "Health care" means:
32          (i) health care as defined in Section 78B-3-403; and
33          (ii) all procedures, supplies, use of health care facilities, and other health care
34     associated with the diagnosis or treatment of a condition for a typical patient, from the time
35     treatment commences until the time treatment ends, including procedures, supplies, and other
36     health care provided by other practitioners.
37          (d) "Health care facility" means the same at that term is defined in Section 26-21-2.
38          (e) "Health care provider" means the same as that term is defined in Section
39     78B-3-403.
40          (2) (a) Except as provided in Subsection (6), a health care provider shall, at a patient's
41     request, provide the patient with an itemized estimate of the patient's cost for the health care.
42          (b) The itemized estimate in Subsection (2)(a) shall:
43          (i) be broken down by procedure or groups of procedures;
44          (ii) show the estimated cost for each procedure or group of procedures for which the
45     patient may be billed; and
46          (iii) (A) for a patient whose health care is not covered by a health benefit plan, include
47     the full price that the patient is required to pay for the health care adjusted for discounts,
48     write-offs, or other billing adjustments provided to uninsured patients with a similar condition;
49     or
50          (B) for a patient whose health care is covered by a health benefit plan, include the full
51     out-of-pocket amount that the patient will be required to pay for the health care, including any
52     copayment, deductible, coinsurance, or any amount that is not covered by the patient's health
53     benefit plan.
54          (3) If a patient requests an itemized estimate under Subsection (2)(a), the health care
55     provider:
56          (a) shall provide the itemized estimate before any health care is performed on the
57     patient;
58          (b) may not delay or deny health care because a patient makes a request under

59     Subsection (2)(a); and
60          (c) may not bill a patient or a patient's health benefit plan more for a procedure or a
61     group of procedures than the amount in the itemized estimate.
62          (4) After a health care provider begins providing health care that is described the
63     itemized estimate under Subsection (2)(a), if a patient needs health care that was not included
64     in the itemized estimate, the health care provider may not bill a patient or a patient's health
65     benefit plan for the health care unless:
66          (a) the health care is provided more than 29 days after the day on which the itemized
67     estimate is provided to the patient; or
68          (b) the health care provider provides the patient with an itemized estimate for the
69     health care before the health care is provided to the patient.
70          (5) A health care provider who provides an itemized estimate to an individual does not
71     create a provider-patient relationship with the individual solely by providing an itemized
72     estimate under this section.
73          (6) A health care provider is not required to provide an itemized estimate under this
74     section for health care to stabilize as defined in 42 U.S.C. Sec. 1395dd a patient with an
75     emergency medical condition as defined in 42 U.S.C. Sec. 1395dd.