No More Surprise Bills: "Purchased and Referred Care Improvement Act of 2025" Ends Patient Liability for Certain Healthcare Services

The "Purchased and Referred Care Improvement Act of 2025" makes a significant change to how healthcare costs are handled for Native Americans using the Indian Health Service (IHS). Specifically, it ensures patients are not on the hook for bills related to "purchased/referred care" – basically, healthcare services that IHS authorizes but aren't directly provided at an IHS facility.

Cash Back for Care

This is the core of the bill: If you're a patient who received authorized purchased/referred care and paid out-of-pocket, you're now entitled to reimbursement. The Secretary of Health and Human Services has 120 days from the bill's enactment to set up a system for getting that money back, and they must consult with Indian Tribes while doing so. Once you submit your paperwork (which you can do electronically or in person), the government has 30 days to pay you back. This applies retroactively, meaning it covers services received before the bill became law, as well as those provided on or after the enactment date. Section 2 of the bill is where all the details are at.

What's "Purchased/Referred Care," Anyway?

The bill also cleans up the language in the Indian Health Care Improvement Act. Instead of "contract health service," they're now using "purchased/referred care." It's a technical change, but it matters for clarity. Think of it like this: if you're sent to a specialist outside of your usual clinic, that's likely "purchased/referred care." (See SEC. 3 for the wording updates). The Secretary has 180 days to update all the official manuals and contracts to reflect this new term.

Real-World Impact: Less Financial Stress

Imagine a scenario: A member of the Oglala Sioux Tribe in South Dakota needs to see a cardiologist, but the nearest IHS facility doesn't have one on staff. IHS authorizes a referral to a specialist in Rapid City. Under the old rules, that patient might have received a bill and been responsible for payment, even after signing agreements. This bill changes that. Now, that patient wouldn't be liable for the cost, and if they had already paid, they could get reimbursed.

The Tribal Opt-In

There's one important caveat: If an Indian Tribe runs its own healthcare programs under certain self-determination acts, these new rules don't automatically apply. The Tribe has to agree to them. This respects Tribal sovereignty and their right to manage their own affairs.

Challenges and Long-Term View

While the bill aims to protect patients, there are potential hurdles. Making sure the reimbursement process is smooth and efficient will be key. There is also the potential for fraudulent claims, making strong documentation requirements important. The long-term success hinges on effective implementation and clear communication to both patients and healthcare providers. Ultimately the bill aims to make accessing necessary healthcare less of a financial burden for Native Americans.