Two price transparency bills moved through Congress last week, and neither will help anyone holding a bill this month. What can help is a set of requirements hospitals have already been under for five years and that most patients have never used.
On July 21, the House Energy and Commerce Committee unanimously approved H.R. 9393, the Lower Costs, More Transparency Act of 2026. A day later, the Senate Health, Education, Labor and Pensions Committee advanced S. 2355, the Patients Deserve Price Tags Act, by a vote of 21 to 1. Both would extend disclosure requirements to ambulatory surgical centers, clinical laboratories, and imaging providers, and both would require insurers to publish negotiated rates. A version of the House bill passed the House in the last Congress and was never taken up by the Senate.
That history is the reason to focus on what already exists.
The Three Things a Hospital Already Owes You
A machine-readable file. Since January 2021, the federal Hospital Price Transparency Rule has required every US hospital to post a comprehensive file listing standard charges for all items and services, including gross charges, discounted cash prices, and payer-specific negotiated rates. It is usually found by searching the hospital's name plus "standard charges" or by looking for a pricing link in the website footer. It is designed for computers rather than people, but it is searchable, and knowing that a negotiated rate exists is leverage on its own.
A consumer-friendly list of shoppable services. Hospitals must also display pricing for at least 300 common shoppable services in plain language, or provide an online price estimator tool that does the same job. This is the more usable of the two, and it covers the planned procedures most people actually shop for, including imaging, common surgeries, and lab panels.
A good faith estimate. Under the No Surprises Act, if you are uninsured or choosing not to use your insurance, a hospital or provider must give you a written estimate of expected charges before scheduled, non-emergency care. You have to ask, or schedule at least a few days ahead, for the timeline to apply.
CMS has also strengthened the file requirements this year. Rules finalized for 2026 require hospitals to publish actual dollar amounts rather than estimated allowed amounts when negotiated rates are expressed as percentages or formulas, with enforcement of the new provisions beginning in April.
The Rights That Matter Most When a Bill Arrives
Two provisions do more practical work than the price files, and both are underused.
The $400 dispute rule. If you received a good faith estimate and your final bill is at least $400 higher than that estimate, you can challenge it through the federal patient-provider dispute resolution process. Keep the estimate. Without it, this option is unavailable.
An itemized bill. You can request a fully itemized statement showing each charge and billing code rather than a summary. Ask for it in writing, and review it before paying anything. Duplicate charges, services never delivered, and coding errors are ordinary rather than exotic, and they are difficult to spot on a summary bill.
Separately, balance billing protections apply automatically. For emergency services, for air ambulance transport from out-of-network providers, and for out-of-network clinicians at an in-network facility whom you did not choose, you generally cannot be billed beyond your in-network cost sharing. That last category matters most, because it covers the anesthesiologist or radiologist you never selected.
It is also worth asking any provider for a discounted cash or self-pay rate. It is frequently lower than the billed charge, though paying cash may mean the amount does not count toward your deductible. Ask before deciding.
Being Honest About Compliance
Anyone who tells you these rules work smoothly is not being straight with you.
Compliance has been uneven since the beginning. Early studies found roughly 17 to 35 percent of hospitals meeting requirements, and a 2025 analysis found only about 36 percent fully compliant with all required file elements. Files are frequently posted but incomplete, outdated, or formatted in ways that defeat the government's own validation tool.
The hospital industry itself argues the framework is not working. The American Hospital Association has stated that the current price transparency framework "is not delivering actionable information for patients," pointing to the difficulty of connecting a listed rate to what a specific patient will owe under a specific plan.
One significant piece is still missing. The No Surprises Act envisioned an advance explanation of benefits, which would give insured patients an estimate of their actual out-of-pocket cost before care. That requirement has not been implemented and remains pending rulemaking. It is the single provision that would most directly answer the question patients ask, and it is the gap the Senate bill is partly aimed at.
CMS can impose penalties for noncompliance, up to $300 per day and as much as $5,500 per day for larger hospitals, and it publishes enforcement actions. If a hospital will not produce a required file, that is reportable to CMS.
How to Actually Use Any of This
Start before care rather than after. For a scheduled procedure, request a good faith estimate in writing and keep it. Ask which providers will be involved and whether each is in network. Check the hospital's shoppable services list or estimator tool, and check one or two other facilities if the procedure is not urgent.
After care, request the itemized bill and compare it against the estimate before paying. If the gap is $400 or more and you have the estimate, use the dispute process. If charges appear for services you did not receive, say so in writing.
Ask about financial assistance early. Nonprofit hospitals are required to maintain written financial assistance policies, and eligibility is often broader than people assume. Asking during a stay is more productive than asking after collections begin.
The confirmed situation is that two transparency bills advanced in committee, and neither is law. The people this affects are anyone facing a scheduled procedure or holding a disputed bill. The most reasonable action is to request a good faith estimate before care and an itemized bill after it. The central uncertainty is whether either bill reaches a floor vote, given that a similar House bill died in the Senate last Congress.
Frequently Asked Questions
What is a good faith estimate and who gets one? A written estimate of expected charges that hospitals and providers must give uninsured or self-pay patients before scheduled, non-emergency care under the No Surprises Act.
What if my bill is much higher than the estimate? If the final bill exceeds the good faith estimate by $400 or more, you can challenge it through the federal patient-provider dispute resolution process. You need the original estimate.
Where do I find a hospital's prices? Search the hospital's website for its machine-readable standard charges file, and look for its shoppable services list or price estimator tool, which is far easier to read.
Can I get an itemized bill? Yes. Request a fully itemized statement showing each charge and code rather than a summary, and review it before paying.
What is balance billing and when am I protected? Being billed beyond your in-network cost sharing by an out-of-network provider. Protections apply for emergency care, air ambulance, and out-of-network clinicians at in-network facilities whom you did not choose.
Do hospitals actually comply with these rules? Unevenly. A 2025 analysis found roughly 36 percent fully compliant with all required file elements. CMS can penalize noncompliance and publishes enforcement actions.
Why can't my insurer tell me what I will owe in advance? The advance explanation of benefits provision of the No Surprises Act has not been implemented and remains pending rulemaking. That is the main gap the pending legislation addresses.
