This bill tightens consumer protections for self-pay patients (those who pay out-of-pocket without insurance) by capping allowable cost overruns beyond the original estimate for medical services.
1. Updated Cap on Final Charges to Self-Pay Patients (Section 1)
A health-care provider or facility must not charge more than:
15% above the original estimate
Or $400 more than the estimate
Whichever is less
Example:
Estimate = $2,000
15% of $2,000 = $300
So the cap is $300 (because it's less than $400)
Final bill cannot exceed $2,300
2. Exceptions for Emergencies or Medically Necessary Add-Ons (Section 1(b)(II))
Providers may exceed the 15%/$400 cap if:
There’s a medical emergency
Or an unforeseen, medically necessary service is required during care
In these cases, the provider must:
Make reasonable efforts to get consent from the patient or their representative
Before performing the service that raises the cost above the cap
3. Enforcement & Consumer Protection
Overcharges beyond these limits without proper justification or consent could be considered a deceptive trade practice under Colorado law.
4. Effective Date (Section 2)
The law takes effect 90 days after the legislative session ends
Unless challenged by referendum petition, in which case it would appear on the November 2026 ballot and take effect only if voter-approved
Summary
HB25-1317 protects self-pay patients by limiting unexpected medical bill increases to a maximum of 15% or $400 beyond the original estimate. It allows exceptions for emergencies, but only with effort to obtain informed consent. The bill aims to reduce surprise billing and promote price transparency in health care.
Summary
Statutory Revision Committee. Under current law, an individual
may request a self-pay estimate of the total cost of an anticipated health-care service (self-pay estimate) from the designated billing or patient services personnel representing the health-care provider or health-care facility providing the service. Unless the patient suffers a medical emergency or other unforeseen circumstance that affects the services provided, the statute states that the final cost of the health-care service must be no more than 15% higher than the self-pay estimate or $400, whichever is less.
The bill corrects a mistake in the statutory language by clarifying
that the $400 qualifier relates to the permissible dollar amount above the cost estimated in the self-pay estimate rather than the maximum allowable cost of the health-care service, regardless of the service provided.
Further, when referencing the exception in statute that, due to an
emergency or unforeseen circumstance, the total cost of services may exceed the self-pay estimate by more than 15% or $400, the bill removes the language whichever is less, as that language is inapplicable when the exception applies.
