Bill to protect Pennsylvania patients from surprise medical bills garners support

June 22--Pennsylvania Insurance Commissioner Teresa Miller announced her support Tuesday for a state proposal that aims to protect patients from surprise medical bills.

Miller's office has been working since fall 2015 on a fix for the problem of the bills, which often come when a patient visits a hospital or doctor that is in their insurance network, and in the course of treatment receives a medical service from someone who is not in their network -- which often costs much more than in-network treatment.

"Over the past two years, I heard from a patient who underwent emergency heart surgery from an out-of-network surgeon; from parents whose baby received needed neonatal care from the only neonatologist available, who was out-of-network; and from women whose mammograms were read at out-of-network facilities, all of whom then received surprise balance bills," Miller said in the release.

The proposal, introduced as House Bill 1553 and Senate Bill 678, would prevent insurers and health care providers from charging out-of-network rates if a patient has made a good-faith effort to get treated in-network.

The proposal would require in-network hospitals and doctors to tell patients if they expect a treatment course to include someone who is out-of-network.

If a patient receives a surprise medical bill, the proposal outlines a procedure to submit the bill to their insurer to sort payment out with the treatment provider.

If the insurer and provider cannot reach an agreement about which one pays, a third-party arbitrator would decide.

The legislation would apply to emergency room care, preventing people from paying out-of-network rates in emergency situations, according to the release.

The leaders of the House Health and Insurance Committee introduced the House bill, which has 31 sponsors.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676, [email protected] or via Twitter @wesventeicher.

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