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Senate of Pennsylvania
Session of 2015 - 2016 Regular Session


Posted: February 3, 2015 12:35 PM
From: Senator David G. Argall
To: All Senate 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 limit that an insurer may 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.

This legislation will be similar to Senate Bill 998 of 2013, which was co-sponsored by Senators Alloway, Rafferty, Gordner, Brubaker, Schwank, Kasunic, Tartaglione, Mensch, Farnese and Browne.

Similar legislation has been unanimously approved by the House of Representatives.

Introduced as SB554