Legislation that would provide protections from surprise medical balance bills to Pennsylvania consumers sponsored by Rep. Tina Pickett (Bradford/Sullivan/Susquehanna) was unanimously reported out of the House Insurance Committee, which Pickett chairs, on Tuesday. House Bill 1862 will next be considered by the full House.
Surprise balance billing happens when an individual gets medical care from a provider he or she believes is in their health insurance plan’s network, but in reality those services came from an out-of-network provider. It can also occur following an accident, when a patient has little or no control over where they are taken to receive care and are often taken to an out-of-network emergency room.
“We’ve heard of a number of such cases around the state, including a patient who 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,” said Pickett. “In another case, a patient 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. You can imagine their shock when those bills arrived in the mail.”
Pickett’s legislation, also known as the “Surprise Balance Bill Protection Act,” would take consumers out of the middle of the reimbursement process and protect them from surprise balance bills.
Specifically, House Bill 1862 would:
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.