THE PRICE ACT

The PRICE Act — Patient Right to Information on Costs and Expenses

Healthcare Price Transparency

Every year, Wisconsin families make some of the most important decisions of their lives without knowing what those decisions will cost. A procedure gets scheduled, care gets delivered, and weeks later a bill arrives that bears no resemblance to anything the patient was told. The PRICE Act fixes that.

Know Before You Go
Every provider must give patients a clear written cost estimate before any scheduled procedure — not a range, not a disclaimer, but a real number based on their actual insurance coverage. Providers must also publish standardized price lists for common procedures publicly online so Wisconsin patients can compare costs the same way they compare prices on anything else.

End Surprise Billing
If a patient didn't choose an out-of-network provider, that provider cannot bill them at out-of-network rates. Disputes between insurers and providers are their problem to resolve — not the patient's.

Insurance Clarity
Insurers must provide plain-language explanations of what is and isn't covered before treatment, issue benefit statements any patient can actually understand, and reform prior authorization so medically necessary care can't be endlessly delayed. Denial reasons must be clear, and appeals must be accessible without a lawyer.

Pharmaceutical Transparency
Drug companies selling in Wisconsin must publicly disclose pricing rationale for high-cost medications. Patients shouldn't choose between medication and mortgage payments without understanding why.

Enforcement
Meaningful fines for non-compliance, regular state audits of pricing disclosures, and a public reporting mechanism so patients can flag violations directly.

Transparency doesn't just protect patients — it creates market pressure that drives costs down over time. That's better for families, employers, and Wisconsin.