Pennsylvania to Hold Hearing on Health Insurer Balance Billing

Pennsylvania Insurance Commissioner Teresa Miller announced that the state’s Insurance Department will hold a public hearing in October on the issue of “balance billing” of health insurance consumers.

Balance billing occurs when a patient receives a bill for health care from a provider who is not in-network with the patient’s insurance company, and so the insurer pays only a small amount, if any, of the out-of-network provider’s charges.

Miller said on Sept. 8 that her department has compiled “dozens of complaints from consumers” in recent years.

In many cases, these patients checked to make sure that their doctors, the facilities, and even the surgeons who were performing the procedures were in-network, yet they still received an additional bill from a health care provider who was out-of-network, she said.

“In many instances, the patient only finds this out when they get a bill for the amount not covered by insurance,” said Miller. “The Pennsylvania Insurance Department and Gov. Tom Wolf’s administration are committed to ensuring consumers and patients do not have the added shock of a large, unexpected medical bill.”

Miller said these patients made an assumption that many would – if the hospital is in-network, then the doctors and other health care professionals working there would be in-network. “This is not always the case,” she said, “and while consumers do bear responsibility to check who is in-network, to expect a patient or their family to research every possible health care provider they may see while in a hospital is asking too much of people whose main concerns are the health issues they face.”

Miller said the hearing would serve as an opportunity to begin exploring options to make sure consumers are informed about their care and do not face these unexpected bills without recourse, as well as to identify possible consumer-friendly solutions to the issue.

Affected consumers and interested parties are invited to testify at the hearing, which will be held on Oct. 1 at the State Museum in Harrisburg, Pennsylvania.