SPRINGFIELD – Nearly one in five insured adults report receiving an unexpected medical bill. As patients continue to navigate complex health care billing systems, State Senator Laura Ellman’s new law will help ensure Illinoisans are better informed about potential charges before receiving care.
“Preventive care should not come with unexpected costs that leave patients confused after the fact,” said Ellman (D-Naperville). “This law is about transparency. Patients deserve to know when a conversation during a wellness visit could result in additional services being billed.”
House Bill 4698 requires medical offices, health care clinics, group practices and other health care organizations to provide notice to patients that additional services discussed during a preventive or wellness visit may result in separate billing charges. The requirement does not apply to individual health care providers.
Under previous law, many preventive services are covered by insurance without cost-sharing requirements. However, if a preventive appointment also includes the evaluation or treatment of an acute or chronic medical condition, the visit may be billed differently and trigger additional out-of-pocket costs.
The law was introduced after a constituent reported receiving an unexpected copay after what they believed was a routine preventive visit. While health care professionals follow established guidance when determining whether services should be coded as preventive or diagnostic, patients are not currently guaranteed advance notice that additional concerns discussed during an appointment could lead to separate billing.
“Patients should be able to make informed decisions about their care without worrying about surprise charges appearing weeks later,” said Ellman. “By providing clear notice upfront, we can help families better understand their coverage and avoid unnecessary confusion.”
House Bill 4698 was signed into law on Friday and takes effect Jan. 1.
