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Pennsylvania State Senate
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=S&SPick=20150&cosponId=19085
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Senate of Pennsylvania
Session of 2015 - 2016 Regular Session

MEMORANDUM

Posted: October 6, 2015 05:33 PM
From: Senator Judith L. Schwank and Sen. Jay Costa
To: All Senate members
Subject: Surprise balance-billing
 
In the opaque world of health care billing and pricing, surprise balance-billing is an increasing problem. In the near future, Senator Costa and I will introduce legislation to end the practice.

Typically, surprise balance-billing occurs here when an in-network provider's health care services include services by another provider outside of the patient's insurance network. The patient usually is unaware that the service is not covered until receiving a separate bill later, in an amount that can easily range into the tens of thousands of dollars or more. To make matters worse, the cost might not be communicated to the patient for months and endanger his or her ability to appeal the charge.

With some 45 million Americans behind on medical bills, and half of all bankruptcies caused by them, patients should not risk being saddled with bills for services they reasonably understood would be covered by their health insurance. More than a dozen states now protect HMO health care consumers and nine protect PPO consumers from out-of-network bills. Many are similar to Pennsylvania in limiting this protection to emergency room visits, but increasingly states are taking a more appropriate position that restricts surprise balance-billing generally. New York adopted a best practice statute this year that is the model for our legislation. Our proposal will :
  1. Protect patients from obligations for out-of-network emergency services or surprise bills beyond the patient's in-network co-payments, co-insurances or deductibles . A bill will be a “surprise”, for example, if a hospital or ambulatory surgical center patient receives services from a provider who, without their knowledge, is out-of-network. If consumers are referred to out-of-network providers without a written consent that indicates they understand the services will be out-of-network and might result in higher out-of-pocket costs, it also will be considered a surprise bill.
  2. Require anyone providing a health care service, including hospitals, physicians and other professionals, group practices, diagnostic and treatment centers, and health centers to disclose their network status, out-of-network rates and relationships with other health care providers; and also to provide advice on how to find such information online and in pre-admission materials.
  3. Require insurers to maintain and provide accurate current directories of network physicians and hospitals and information about out-of-network rates.
  4. Ensure that patients are removed from any payment dispute between the insurer and provider if they complete an "Assignment of benefits" that allows a provider to directly pursue payment from the patient's health plan.
We hope you will join us in co-sponsoring this important piece of consumer legislation that fairly protects the interests of all parties.



Introduced as SB1158