Patients could challenge health care overcharges and seek refunds

Medical facilities would investigate reported overcharges and respond to the patient. This applies when a patient tells a medical facility that its bill contains specific charges the patient believes are wrong. The patient must identify the specific charges they believe are wrong. The facility may say it needs more time to investigate. If it will not cancel or refund all disputed charges, it must give the patient the consumer assistance office's contact information. The facility must respond within 30 days after the patient reports the charges.

Health care billing entities would investigate reported overcharges and respond to the patient. A billing entity means a solo practitioner, group practice, or provider's employer that receives payment for the provider's care. The patient must identify the specific charges they believe are wrong. The billing entity may say it needs more time to investigate. If it will not cancel or refund all disputed charges, it must give the patient the consumer assistance office's contact information. While the billing entity or office reviews a charge, the provider and billing entity may bill for other care, but not the care under review. The 30-day response period starts when the patient reports the charges. The billing pause lasts during the investigation or any office review.

Facilities and billing entities would refund patient overpayments. This applies when a medical facility or billing entity receives an overpayment from a patient. A facility may apply the overpayment to the patient's other current outstanding bills. A billing entity may apply it to current outstanding bills for care from the same provider. A late refund could lead to a fine equal to 10 percent of the overpayment, capped at $5,000. No other administrative sanction applies for that failure. The 60-day period starts when the facility or billing entity determines that an overpayment was made.

The Governor's Consumer Health Advocate would review certain bills and help consumers address overcharges and overpayments. The duty covers medical facility and health care provider bills that consumers believe are erroneous.