BLOG: Insurance Commissioner Announces Proposed Solution to Protect Health Care Consumers from Surprise Balance Bills (ROUND-UP)

By: Sophie Stone, Deputy Press Secretary

January 20, 2016

Yesterday, Insurance Commissioner Teresa Miller announced a proposed solution to protect health care consumers from surprise balance bills. The Pennsylvania Insurance Department will be soliciting public comment on the proposal.

Surprise balance bills happen when a consumer receives emergency care, or has made a good faith effort to use health care providers and facilities in the consumer’s health insurance network, but has unexpectedly received a service from a provider or at a facility that is out-of-network, then receives a bill for that service.

The goal of this proposal is to take consumers out of billing disputes between insurers and health care providers. In order to meet this goal, the Department is looking forward to working collaboratively with the General Assembly, consumers, and stakeholder groups to draft legislation on this issue.

Check out some of the coverage of the commissioner’s announcement:

Scranton Times-Tribune: Editorial: State sides with consumers.

“The state Insurance Department is ready to help shield consumers from some of the worst fallout from the rapidly changing health care industry… State Insurance Commissioner Teresa Miller has proposed a sound solution that makes out-of-network treatment the problem of providers and insurers, rather than consumers. The proposal, akin to solutions already in effect in several other states, would remove consumers from payment disputes between providers and insurers… This is a nonpartisan solution that lawmakers should embrace. And it’s a step toward an even better solution — a state law that would require all providers to accept any valid insurance, with an arbitration system to prevent insurers or providers from gaining an unfair advantage. Ms. Miller’s proposal is a reminder that the consumer is a vital but often forgotten party in the rapidly changing health care industry. The Legislature should move quickly to adopt the badly needed consumer protection.”

Reading Eagle: Arbitration suggested for medical billing disputes.

“After months studying a growing balance billing problem, Pennsylvania Insurance Commissioner Teresa D. Miller suggests patients should be removed from the dispute… In July, state Sen. Judy Schwank and U.S. Sen. Bob Casey Jr. wrote letters to state and federal departments with oversight looking for possible fixes to the problem… Schwank said Miller’s proposal strikes a good balance that she could support. ‘We have an insurance commissioner in our corner,’ the Ruscombmanor Township Democrat said… ‘It’s going to eliminate people from having to pay for something they shouldn’t have to pay for,’ said [Jay Mahoney, an insurance agent with Gallen Insurance in Cumru Townshi], who described the proposal as a win for patients. ‘It’s not confrontational. I think working it out this way is the right way to handle the situation.’”

Pittsburgh Tribune-Review: Pa. insurance regulator eyes an end to ‘surprise’ medical bills.

“Pennsylvania’s insurance commissioner wants to remove the surprise factor from bills for out-of-network medical care. On Tuesday, Commissioner Teresa Miller unveiled a proposal aimed at easing financial pain for patients adversely impacted by so-called surprise balance bills. She’s asking the public to offer feedback online to the proposal that she hopes eventually will lead to legislation… Janice Nathan of Squirrel Hill got caught up in a balance bill dispute last year after being charged $329 for an out-of-network stress test. She underwent the test at UPMC Shadyside, an in-network facility under her plan, but learned after receiving a bill that the physician performing her procedure was an out-of-network contractor… ‘I think this new idea is wonderful,’ she said of Miller’s proposal. ‘It’s going to protect a lot of people who won’t have to waste the time and energy that I did. My bill was small compared to some of these others.’”

Philadelphia Inquirer: Gov. Wolf proposes bill to protect patients from ‘balance billing.’

“The Wolf administration on Tuesday proposed strong consumer protections against surprise bills from providers outside patients’ health insurance networks, tackling an issue that has swiftly gained prominence nationwide and largely eluded effective political solutions. The proposal, which includes a 19-page draft bill – it has neither been introduced nor debated by lawmakers – removes consumers from disputes between providers and insurers over out-of-network bills, and requires both sides to agree to binding arbitration of disputes on a tight timeline or face hefty fines… Surprise bills, sometimes called balance billing, have become a major consumer issue in just the last few years. A Consumer Reports survey last year found that nearly one-third of privately insured Americans reported receiving unexpected bills of all kinds.”

AP: Insurance regulator eyes an end to ‘surprise’ medical bills.

“Pennsylvania’s insurance regulator is floating a proposal to protect people against expensive medical bills at out-of-network rates, including emergency care. Insurance Commissioner Teresa Miller said Tuesday her goal is to take consumers out of billing disputes between insurers and health care providers. Under her proposal, the consumer would be liable for nothing more than they would pay a provider for an in-network service. Providers and insurers would have to work out any additional payment, if there’s anything beyond that.”


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