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HF 4225

Amount a provider can charge an enrollee for denied covered services limited.

2025-2026 Regular Session Introduced by Matt Norris

Bill restricts provider billing to patients for denied claims on insured-covered services, shifting financial responsibility from patients to providers or insurers.

Introduction and first reading, referred to Commerce Finance and Policy
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Bill Summary · HF 4225

Legislative bill overview

HF 4225 limits the amount healthcare providers can charge patients when insurance denies coverage for services that the insurance plan lists as covered. The bill establishes protections so patients aren't stuck with large bills resulting from insurance claim denials on services their plan supposedly covers.

Why is this important

Insurance claim denials create significant financial hardship for patients, particularly when they occur after services are rendered. This bill addresses situations where patients follow their insurance's coverage guidelines but still face denial and subsequent billing—a common source of medical debt and patient complaints about insurance practices.

Potential points of contention

  • Provider liability concerns: Healthcare providers may argue that restricting their ability to bill patients for denied claims shifts financial risk inappropriately onto them, potentially affecting their ability to pursue reimbursement from insurers
  • Insurance coverage clarity: The bill assumes clear distinctions between "covered" and "denied" services, but real-world insurance policies contain complex exclusions, pre-authorization requirements, and conditional coverage that may blur these lines
  • Implementation costs: Providers would need systems to verify coverage status before service delivery; increased administrative burden could raise healthcare costs
  • Scope questions: Unclear whether this applies only to network providers, what specific claim denial reasons are covered, and how retroactive denials are handled

Compiled from official sources — confirm details with the bill’s official record.

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