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Senate of Pennsylvania
Session of 2019 - 2020 Regular Session


Posted: February 5, 2019 04:10 PM
From: Senator Judith L. Schwank and Sen. Jay Costa
To: All Senate members
Subject: Surprise Balance Billing
We will shortly re-introduce legislation to shield patients against health care providers' surprise "balance" bills.

This problem occurs when a patient who has health insurance unwittingly receives services from a provider outside of the insurer's network, and the patient is then billed for them. Typically, this happens when a patient sees an in-network provider for care but related services, for example, reading radiological images, are handled by out-of-network providers of whom the patient is unaware. It also typically arises in emergency situations, where a patient has little or no choice in her care provider. When providers are out-of-network, patients can find themselves with unexpected bills that run well into tens of thousands of dollars. Even when such a bill is resolved without payment by the patient, the process itself can lead to long months of emotional and financial stress and damage the patient's credit.

States increasingly are acting to protect patients in these situations. Our proposal is based on lengthy discussions the Department of Insurance held with key stakeholders, and would protect patients against fees for services that would have been covered if the care had been obtained in-network, while also providing the insurer and health care provider with last-best offer binding arbitration when they cannot agree on an appropriate payment for the services provided. We introduced this legislation last session as SB 678, and co-sponsors included Senators Fontana, Tartaglione, Hughes, Yudichak, Browne, Street, Vogel and Farnese.

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

Introduced as SB822