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Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20150&cosponId=17871
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House of Representatives
Session of 2015 - 2016 Regular Session

MEMORANDUM

Posted: March 25, 2015 03:42 PM
From: Representative Stephen Barrar
To: All House members
Subject: Retroactive Review Legislation
 
In the near future, I will introduce legislation that would limit the ability of insurance companies to retroactively deny reimbursement to health care providers.

Insurance companies may retroactively deny reimbursement to health care providers at any time and unilaterally reduce future payments to recover the denied amount. My legislation would protect providers from post-payment review by requiring insurance carriers to review treatment plans, claim forms and billing statements within a reasonable amount of time. Specifically, my legislation would require that an insurer only retroactively deny reimbursement during a 12-month period after the date the insurer paid the health care provider. Due to advances in technology, a one-year period of review should not create an undue burden on insurers.

The legislation would also require a written statement from the insurer specifying the basis for retroactive denial.



Introduced as HB1178