PA – Legislature Takes Aim at Balance Billing

July 2017 ~

Pennsylvania legislators have introduced two bills that seek to protect patients from surprise medical bills for both emergency and non-emergency care provided certain situations.

The Surprise Balance Bill Protection Act (House Bill No.1553) and the Health Insurance Surprise Balance Bill Protection Act (Senate Bill 678) would apply to situations where the patient unknowingly receives care from an out-of-network provider in both emergency and non-emergency situations.

The Surprise Balance Bill Protection Act bill would ensure patients are only held responsible for in-network cost sharing. The legislation would require health care providers to bill the insurer rather than the patient and any disputes over bills would be worked out by the insurer and the health care provider. An independent arbitration process (involving only the insurer and medical provider, and not the patient) would be used in situations where insurers and medical providers can’t reach agreement.

Similar to the Surprise Balance Bill Protection Act, the Health Insurance Surprise Balance Bill Protection Act includes additional safeguards to help protect consumers against surprise out-of-network medical bills.

Insurance Commissioner Teresa Miller commended the bills’ efforts stating, “Surprise balance bills happen when consumers make a good faith effort to use providers and facilities in their insurance network, but receive a service from an out-of-network provider or facility during treatment, and then get a balance bill for this service.” Miller continued,  “As part of Governor Wolf’s commitment to consumer protection, I have been working with legislators on a proposal to shield consumers from the often large and unexpected bills since I held a public hearing on the topic in October, 2015, and am gratified to have the support of key committee chairs on this important issue.”

The House and the Senate bill are each in committee and have not yet received any votes.

Source(s): Becker’s Hospital Review; PennLive; Medicare Report;