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Tennesseans are facing a health care affordability crisis, driven by rising prices for drugs and services, higher use of services, claims coding trends and more.

New proposed legislation in the Tennessee General Assembly may drive spending up even further. Provider lobbying groups are pushing for these changes, which could increase costs for our members and the businesses that provide employee health coverage.

We’ve been educating stakeholders about these bills because Tennessee is our home state and we owe it to our neighbors.

Now, we’re taking our role as an advocate one step further by working with legislators to introduce the Health Care Transparency and Fraud Prevention Act (Senate Bill 2186/House Bill 2170) in the Tennessee General Assembly.

If passed, this legislation would deliver:

• Stronger financial protections for patients
• Safeguards against billing errors and fraud
• Greater transparency from providers and drug makers
• Strong oversight and legal protections for members

Below, we’ll break down each major theme of the bill, including what would change and how it would serve our neighbors.

Giving patients clearer bills and more time to respond

What would change

• Providers would be required to give patients clear, itemized medical bills upon request.
• Patients would receive good‑faith cost estimates in advance for scheduled services when costs are expected to be high.
• Providers would have to give written notice and time to review a bill before sending it to collections — and pause collections if a bill is disputed.
• Medical debt could not be reported to credit agencies without proper notice and sufficient time for patients to respond.

Why it matters to Tennesseans

Medical bills are a leading source of confusion and financial stress for Tennessee families. These protections would give people more time, more information and a clearer path to ask questions or resolve errors. 

Making sure patients are billed only for the care they receive

What would change

• Providers would face penalties for repeated or patterned violations of billing for services not actually rendered.
• Providers would be required to maintain accurate documentation to support claims filings.
• Stronger standards would help prevent practices like upcoding of intensity levels or unbundling of services that should be billed together.

Why it matters to Tennesseans

Billing errors and inappropriate practices raise costs across the health care system, affecting patients, employers and taxpayers alike. Stronger safeguards help curb increases in premiums and out-of-pocket expenses.

Requiring transparency from providers and corporate owners

What would change

• Providers would be required to report suspected patterns of fraudulent billing to state investigators.
• Financial relationships that could influence referrals would need to be disclosed to patients in writing.
• Facilities owned or controlled by private equity or corporate entities would have to clearly disclose ownership information.
• Quotas or financial policies that compromise patient safety or medical judgment would be prohibited.

Why it matters to Tennesseans

Patients deserve to know who is involved in their care and whether financial incentives could influence medical decisions. These requirements would promote transparency, reinforce trust, and help make sure care decisions are guided by patient needs — not financial pressures behind the scenes.

Making prescription drug prices clearer

What would change

• Drug manufacturers would be required to notify the state in advance of significant price increases and explain what’s driving those increases.
• Manufacturers with substantial sales in Tennessee would submit annual public reports detailing revenues, research and development spending, advertising costs and profit margins.
• Prescription drug advertisements would be required to disclose a medication’s list price.
• Pharmacies would have to inform patients when paying cash would be less expensive than using insurance.

Why it matters to Tennesseans

Rising prescription drug prices are one of the fastest‑growing drivers of health care costs. Greater transparency would help consumers understand what they’re paying for, avoid paying more than necessary, and see what’s behind price increases that affect premiums and out‑of‑pocket costs.

Strengthening enforcement and accountability

What would change

• The Tennessee Department of Commerce and Insurance would investigate violations and impose penalties or corrective actions when appropriate.
• Members harmed by fraudulent or unethical billing practices could seek compensation in court.
• The legislature would receive an annual public report summarizing complaints, investigations, penalties and recommended improvements.

Why it matters to Tennesseans

Strong protections only work if they’re enforced. Oversight and reporting help make sure violations are addressed, bad actors are held accountable, and Tennesseans have recourse when they’re harmed.

Building a fairer, more transparent system

For more than 80 years, we’ve focused on affordability and being good corporate citizens of our home state. And we want Tennessee’s healthcare system to work better for everyone.

Here are some facts about how we’re doing our part:

• As a not-for-profit, we don’t have owners or shareholders who get payouts from our operations.
• We’re also one of the largest taxpayers in Tennessee.
• We are required by law to spend the vast majority of premiums on the medical treatments our members need. For the past five years, 88-90% of premiums have gone to pay claims. Any after-tax margin we earn goes into our reserves, making sure we can pay claims even if we face challenging circumstances.
• We’re transparent about our financial stewardship, publishing a report on BCBSTnews.com every year.

The Healthcare Transparency and Fraud Prevention Act is designed to restore trust and fairness in our state’s healthcare system by promoting greater accountability and transparency for other healthcare organizations in Tennessee.