H.R. 10024: Health Insurance Transparency for Patients Act

This bill would require health insurance companies and Medicare Advantage plans to publicly disclose more information about how they handle coverage requests, including when they deny them.

What insurers would have to publish

For each plan year, health insurers offering group or individual coverage, and Medicare Advantage organizations, would have to report information to the federal government and post it on their own websites. The information would have to be presented in a way that is easy for consumers to understand.

The required disclosures would include:

• The number and percentage of coverage requests that were denied, in whole or in part, on the first review.
• The number and percentage of coverage requests that were approved on the first review.
• The number and percentage of denied coverage requests that were appealed, and how many of those appeals led to a full or partial reversal of the denial.
• A list of all covered items and services that require prior authorization.

How the information would be broken down

The reported data would have to be separated by several categories, including:

• The type of request.
• The reason for the denial.
• How the denial was reviewed, including whether a fully automated system, an algorithm, or a person made the decision.
• The type of item or service involved.
• How long it took to decide the request or appeal, measured in days and hours.
• Whether an appeal was handled on an expedited basis.

Federal standards and public posting

The Secretary of Health and Human Services would have to create standard definitions and reporting formats so the information is consistent, comparable, and consumer-friendly. The bill also says, to the extent practical, insurers should not have to gather extra information from health care providers just to make these reports.

Each year, the Department of Health and Human Services would post the submitted information on its own website.

When it would take effect

The new reporting rules would apply to plan years beginning on or after January 1 of the first year after the bill becomes law.

Relevant Companies

• UNH — UnitedHealth Group, a major health insurer and Medicare Advantage provider that would likely have to change reporting and disclosure practices.
• HUM — Humana, a large Medicare Advantage insurer that would be directly affected by the new disclosure requirements.
• CVS — CVS Health, through its Aetna insurance business and Medicare Advantage operations, would likely need to comply with the reporting rules.
• ELV — Elevance Health, a major commercial insurer that would likely be affected by the new transparency requirements.
• CI — Cigna, a large health insurer that could be impacted by the added disclosure and reporting obligations.
• HCA — HCA Healthcare is not an insurer, but could be indirectly affected if insurers change prior authorization and claims processes that interact with providers.