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Senate of Pennsylvania
Session of 2017 - 2018 Regular Session


Posted: February 23, 2017 02:54 PM
From: Senator Judith L. Schwank and Sen. Donald C. White, Sen. Jay Costa
To: All Senate members
Subject: Balance billing
We will shortly introduce legislation to protect patients from surprise balance bills from health care providers.

This is a practice that occurs when a patient with health insurance coverage unknowingly receives services from an out-of-network provider. It typically happens when a patient sees an in-network provider for care, but related services are handled by out-of network provides such as anesthesiologists or radiologists whom the patient never sees, and in emergency situations where a patient has little or no ability to select in advance the facility or person providing care. Because the providers are out-of-network, patients caught in these situations can find themselves receiving unanticipated bills that run well into the tens of thousands of dollars. Even if the matter is resolved without further payment by the patient, the process can lead to months of emotional and financial stress for patients.

States increasingly are acting to protect consumers caught in these situations. Our proposal is based on discussions the Department of Insurance held during the last two years with various stakeholders, and will protect patients from all fees for these services except the ones they would face if they were provided in-network, while at the same time also protecting insurers and health care providers with last-best offer binding arbitration when they cannot agree on an appropriate payment for the services.  

We hope you will join us in co-sponsoring this important piece of legislation.

Introduced as SB678