Health Insurance Transparency for Patients Act

This bill, titled the "Health Insurance Transparency for Patients Act," seeks to increase transparency in health care coverage decisions by amending the Public Health Service Act and the Social Security Act. It requires both health insurance issuers offering group or individual coverage and Medicare Advantage (MA) organizations to make specific information publicly available on their websites annually. The mandated disclosures include deidentified data on the percentage and number of coverage requests that were denied or approved on initial review, as well as the outcomes of appeals, including reversals. This information must be disaggregated by several factors, such as the type of request, the reason for denial, and the process used for review, including whether it involved automated systems or individual assessment. Additionally, the time elapsed for determinations and whether appeals were expedited must be reported. Furthermore, these entities must provide a comprehensive list of all covered items or services that are subject to prior authorization . The Secretary of Health and Human Services is tasked with establishing standard definitions and reporting formats to ensure the data is accurate, comparable, and consumer-friendly, while minimizing additional burdens on providers. The Secretary will also publish this aggregated information annually on the Department of Health and Human Services website. The term "coverage request" encompasses both claims for covered items or services and prior authorization requests. These new disclosure requirements will apply to plan years beginning on or after January 1 of the first year following the bill's enactment, aiming to empower consumers with clearer insights into their health care coverage experiences.