In the near future, we plan to introduce legislation that would protect consumers from surprise balance bills from medical providers. Surprise balance billing happens when someone gets medical care from providers and at facilities they believe are in their health insurance plan’s network, but unknowingly receives services from an out-of-network provider. Surprise balance billing can also occur following an emergency, when a consumer has little or no control over where they are taken to receive care, and are often taken to an out-of-network emergency room. Here are some real life examples:
Our legislation, titled the “Surprise Balance Bill Protection Act”, would take consumers out of the middle of the reimbursement process and protect them from the kind of bills that were mentioned above. Specifically, our legislation would:
- A consumer from State College was billed over $2,000 for blood tests that were taken at an in-network hospital by an in-network doctor, but sent for analysis at an out-of-network lab.
- A consumer from Lancaster had surgery at an in-network hospital performed by an in-network surgeon, but was billed $1,300 for services provided by an out-of-network anesthesiologist.
- A consumer from Scranton had a baby at an in-network hospital delivered by an in-network OB/GYN, but complications led the baby to be seen by an out-of-network neonatologist, resulting in a surprise $750 bill.
After reviewing efforts in other states to address this problem and working closely with stakeholders in Pennsylvania, we am confident that we can address this important consumer protection issue.
- Ensure that consumers are only responsible for their in-network cost-sharing obligations.
- Instruct providers to bill insurers directly, while also allowing consumers to trigger protections if they do receive a balance bill.
- Instruct insurers to negotiate with providers to determine fair payment for the services that consumers receive.
- Establish an independent arbitration process to determine fair payment if the insurer and provider are unable to come to an agreement on the reimbursement.
Please join us in co-sponsoring this important legislation.