§ 16.130.010. Estimate of charges upon request.  


Latest version.
  • A.

    Disclosures by Practitioner. Upon request by a patient, before providing nonemergency medical services and not later than ten business days after receiving the request, a health care practitioner shall provide, in writing or by electronic means, an estimate of reasonably anticipated charges to treat the patient's or prospective patient's specific condition. An estimate need not address an entire course of treatment, if the fact that the estimate discloses charges for only a portion of the anticipated total course of treatment is disclosed in the estimate. For charges whose magnitude will vary significantly in response to conditions not reasonably knowable prior to the provision of medical services, a reasonable range of charges may be provided.

    B.

    Disclosures by Facility. Upon request by a patient, before providing nonemergency medical services and not later than ten business days after receiving the request, a health care facility shall provide, in writing or by electronic means, an estimate of reasonably anticipated charges to treat the patient's condition at the facility. An estimate need not address an entire course of treatment, if the fact that the estimate discloses charges for only a portion of the anticipated total course of treatment is disclosed in the estimate. For charges whose magnitude will vary significantly in response to conditions not reasonably knowable prior to the provision of medical services, a reasonable range of charges may be provided.

    C.

    Required components of estimate. An estimate of reasonably anticipated charges required by this section shall include:

    1.

    Description of procedures, services, products, supplies and other items. A brief description, in plain language comprehensible to an ordinary layperson, of all procedures, services, products or supplies for which the practitioner or facility intends, or is likely, to charge.

    2.

    Billing codes. For each procedure, service, product, supply or other item that will result in a charge and that corresponds to a standardized billing code, the then-current code for each such procedure, service, product supply or other item. For purposes of this section, a "standardized billing code" includes, but is not necessarily limited to, an International Classification of Diseases (ICD) code, a Current Procedural Terminology (CPT) code published by the American Medical Association, a Current Dental Terminology (CDT) code published by the American Dental Association, or a code used in the Healthcare Common Procedure Coding System (HCPCS).

    3.

    Facility or additional fees. Any facility or additional fees, along with a brief statement, in plain language comprehensible to an ordinary layperson, describing the fee.

    4.

    "Rack" or individualized charges. For each reasonably anticipated charge, the practitioner or facility shall provide either:

    a.

    The amount that the practitioner or facility would charge a person with no health care insurance, along with a clear indication that the charges being disclosed do not account for any insurance benefits to which the patient or prospective patient may be entitled and that payment may vary by insurer, or

    b.

    The amount that the practitioner or facility anticipates charging the person requesting the estimate, accounting for any insurance policy held by the person and any status of the person that would affect a charge; for purpose of this section, "status" includes, but is not limited to Alaska Native, American Indian, veteran and indigent status.

    5.

    Identity of others that may charge. The identity, or suspected identity of any other person, entity or facility that may charge the patient or prospective patient in connection with any procedure, service, product or supply referenced in the estimate, along with an indication of whether the amount of any such charges have been included in the estimate, or would be in addition to the total amount of charges estimated.

    6.

    Notice to consult with insurer. A notice that the patient or prospective patient may contact his or her health insurer for additional information concerning cost-sharing responsibilities.

    7.

    Disclosure of in-network or out-of-network status. An accurate notice, substantially in one of the following forms:

    a.

    "[Name of health care provider or facility] is a contracted, in-network, preferred provider for ONLY the following plan networks: [list each such network, e.g. Premera Heritage Select, Premera Heritage Plus, etc.; else, list "NONE. YOU MAY INCURE OUT-OF-NETWORK CHARGERS"]",

    b.

    "[Name of health care provider or facility] is a contracted, in-network, preferred provider for your insurance plan.", or

    c.

    "[Name of health care provider or facility] IS NOT a contracted, in-network, preferred provider for your insurance plan. YOU MAY INCUR OUT-OF-NETWORK CHARGES."

    D.

    Required posting. Health care practitioners and health care facilities shall conspicuously post a sign in patient registration areas containing at least the following language: "You will be provided with an estimate of the anticipated charges of your care, upon request. Please do not hesitate to ask for information. Anchorage Municipal Code 16.130.010."

    E.

    Penalties.

    1.

    Failure to timely provide an estimate required by this section shall result in a daily fine of $100.00 until the estimate is provided to the patient or prospective patient. The total fine may not exceed $1,000.00.

    2.

    Failure or to make the posting required by this section shall result in a daily fine of $100.00 until the failure is cured. The total fine may not exceed $1,000.00.

(AO No. 2017-26 , § 1, 5-1-17)