A bipartisan group of legislators, including Sens. Dan Feyen, John Jagler and Jon Erpenbach along with Reps. Pat Snyder, Tony Kurtz and Lisa Subeck, introduced WHA-supported legislation that would clarify the ability for Wisconsin health care providers to offer discounts to their patients who owe health insurance cost-sharing amounts, such as copayments, coinsurance, and deductibles, and pay those amounts timely.
As providers have weighed offering prompt-pay discounts to their patients, they have considered the applicability of a number of federal and state laws, guidance and other factors. For example, there is an unpublished 2004 Wisconsin attorney general opinion that stated if certain conditions are met, prompt-pay discounts are allowed under Wisconsin law. Other views, however, have discouraged the practice.
“Health insurance plans often require health care consumers to pay a portion of their health care costs through various cost sharing arrangements, such as copayments, coinsurance and deductibles. These out-of-pocket costs, which have been increasing over the years, are not only a significant burden for consumers to pay, but also a cost for providers to collect,” said the bipartisan group of six lawmakers in a memo to their colleagues requesting lawmakers co-sponsor the proposal. They added, “This bill is a common-sense way to help both patients reduce their out-of-pocket costs and health care providers avoid collection costs.”
Under this bill, a discount for the prompt payment of a coinsurance or deductible may be offered when the following conditions are met:
- The discount is offered without regard to the reason the individual was seeking the product or service;
- The discount amount bears a reasonable relationship to the amount that the health care provider would avoid in collection costs;
- The health care provider notifies the health insurance company of the discount;
- The health care provider does not, unless required by law, publicly advertise this discount;
- The cost of the discount is not shifted to any other payer; and
- The health care provider does not include the discount in a price reduction agreement with a third-party payer except as allowed by law.
An identical proposal was introduced during the last legislative session. The bill received broad, bipartisan support and passed the state Assembly, but was stalled, along with many other pieces of legislation, in the Senate due to the COVID-19 pandemic.
To contact your state lawmaker to express support for this proposal and ask him or her to co-sponsor the legislation, email Kyle O’Brien
or Kari Hofer
on WHA’s government relations team.