New Price Transparency Bill Mandates Hospitals Post Negotiated Rates Monthly, Bans Insurance Gag Clauses

The aptly named Patients Deserve Price Tags Act is a massive overhaul of how healthcare costs are disclosed, aiming to end the era of surprise bills and secret pricing. This bill doesn't just ask hospitals to be slightly more transparent; it demands they spill the beans on nearly every price point they have. Starting as early as January 1, 2026, hospitals must update their detailed lists of standard charges—including the secret rates they negotiate with every specific insurer and plan—every single month (Sec. 2). They also have to list a discounted cash price and are legally bound to accept that price as full payment from any patient who chooses to pay out of pocket, regardless of insurance status. This is huge for self-pay individuals and those with high deductibles.

The End of the Pricing Black Box

For consumers, the most immediate change will be seeing actual negotiated rates. Imagine a routine MRI: Instead of just seeing the $5,000 sticker price, you’ll see that the hospital negotiated a $1,200 rate with Blue Cross PPO Plan A, but only $950 with Cigna HMO Plan B (Sec. 2). This level of detail extends to clinical diagnostic labs, imaging centers, and ambulatory surgical centers (ASCs) starting July 1, 2027 (Sec. 3, 4, 5). If you’re shopping for a colonoscopy or a complex blood panel, you’ll finally have the data to compare costs before you even schedule the appointment, which could save you hundreds or thousands of dollars.

Insurance Plans Must Show Their Work

The bill also drags health insurers into the light. Starting January 1, 2026, health plans must provide a real-time, self-service cost tool that instantly shows your out-of-pocket costs, how much you’ve met toward your deductible, and whether prior authorization is needed for a specific service (Sec. 6). If the tool gives you wrong information and you end up getting billed more, the plan must hold you harmless for that extra amount. This means no more crossing your fingers and hoping the online estimate was accurate.

Furthermore, after you receive care, plans must send a detailed Explanation of Benefits (EOB) within 45 days. This EOB must itemize every single service with its billing code, the plan’s payment amount, and exactly what you owe (Sec. 10). For busy people, this replaces the often confusing summary with a clear, itemized receipt, making it much easier to spot errors or overcharges.

Cutting the Gag Clauses on Data

Perhaps the most significant—and wonkiest—part of this bill is its attack on the secrecy surrounding group health plans. Many large employers use third-party administrators (TPAs) or Pharmacy Benefit Managers (PBMs) to handle their healthcare benefits. These service providers often include “gag clauses” in contracts that prevent the employer (the plan fiduciary) from seeing the raw claims data, negotiated rebates, or true payment formulas (Sec. 7, 8).

This bill explicitly voids those clauses, declaring them against public policy. PBMs and TPAs must now grant the plan fiduciary access to all claims data, payment formulas, and detailed information about rebates and fees they collect, with access provided in a daily batch and within 15 days of request (Sec. 7). If a PBM tries to limit this data access, they face a staggering penalty of $100,000 per day (Sec. 8). This change empowers employers to audit their plans effectively, potentially lowering costs by ensuring PBMs are passing along savings and not hiding fees.

Enforcement and the Binding Estimate

The bill backs up these mandates with serious financial consequences. Hospitals that fail to post their required pricing data face daily penalties that scale with their size, starting at up to $300/day for small hospitals and going up to $25 per bed per day for large facilities (Sec. 2). Health plans can be fined up to $300 per member per day for failing to comply with the new transparency rules (Sec. 6).

Finally, the bill aims to eliminate surprise bills by making initial cost estimates binding (Sec. 11). Providers must send you an itemized bill within 30 days of final payment from your insurer. Crucially, they cannot pursue collections against you for an amount higher than the initial good faith estimate they provided, unless they can prove the extra charges were due to unexpected medical complications. The burden of proof is squarely on the provider, not the patient, offering strong protection against unexpected bills.