Health Insurance Transparency for Patients Act

More coverage decision data for patients

This bill would require health insurers and Medicare Advantage organizations to publish annual, deidentified data about coverage requests. Each issuer and MA plan would post the data on its website and submit it to HHS within one year after the plan year ends. The reports would show numbers and percentages of requests denied or approved on initial review, appeals and any reversals, and a list of items or services subject to prior authorization. Data would be broken down by request type, reason for denial, review method (including fully automated or AI-driven, algorithmic, or human review), service type, time to decision in days and hours, and whether appeals were expedited. The HHS Secretary would set standard definitions and formats, require consumer-friendly presentation, protect privacy by deidentifying data, and publish the information annually on the HHS website. The rule would apply to plan years beginning on or after January 1 of the first year beginning after enactment.