Pennsylvania Insurance Commissioner Applauds Introduction of Legislation to Protect Consumers from Surprise Balance Bills
"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," Commissioner Miller said. "As part of
The legislation, HB 1553, which has 31 sponsors including Health and
"During testimony at the public hearing and in correspondence 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 neo-natal 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," Commissioner Miller said. "These stories make it clear this practice must stop."
If the insurer and provider or facility cannot reach agreement on payment for out-of-network services, the matter would be submitted to arbitration, with each side submitting its last best offer. In what is known as "baseball arbitration", the arbitrator would then choose one of the offers, and this decision would be binding on both parties. The consumer would not be involved in this process.
Commissioner Miller emphasized this legislation would apply to emergency room care. She noted in emergency situations consumers often have no choice as to which provider or facility delivers care, and thus have no say in whether the care is in-network.
Similar legislation, SB 678, has been introduced in the
"It's very important to get the patient out of this equation. Somebody who has done everything reasonable to make sure they are within their network should not face hidden, and often expensive, bills because of struggles between providers and insurers. Too often that's what is happening now,"
"When patients receive medical care, they and their families should be focusing on getting better, and not worrying about whether a big medical bill will be arriving in the next day's mail," Commissioner Miller said. "This legislation will go a long way toward making that happen in
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