Pennsylvania Eyes an End to ‘Surprise’ Medical Bills

Pennsylvania’s insurance regulator is floating a proposal to protect Pennsylvanians against expensive medical bills at out-of-network rates, including emergency care.

Insurance Commissioner Teresa Miller said on Jan. 19 that her goal is to take consumers out of billing disputes between health insurers and health care providers.

Under her proposal, the consumer would be liable for nothing more than what they would pay a provider for an in-network service. Providers and health insurers would have to work out any additional payment, if there’s anything beyond that.

Miller held an informational hearing last fall on the problem of “surprise balance” bills being sent to patients who thought their treatment was covered by their insurance network.

“At a public hearing in October, I heard from consumers who, despite their best efforts to use providers in their health insurance network, still received out-of-network bills that were in the hundreds – and in some cases thousands – of dollars,” Miller said.

“When an individual is faced with a major medical issue, that person needs to concentrate on getting well, and not worry about whether an unexpected medical bill is coming,” she added.

Miller wants her 19-page proposal to result in legislation. It’s on the Insurance Department’s website for public comment through Feb. 29.