Penn. to Hold Hearing on Balance Billing of Health Insurance Consumers

September 10, 2015

Pennsylvania Insurance Commissioner Teresa Miller announced that her department will hold a public hearing 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 their insurance company pays only a small amount, if any, of the out-of-network provider’s charges.

Miller said in her Sept. 8 announcement 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.

The practice of balance billing is particularly troubling when the patient uses a doctor and facility that is in-network according to their health insurance, but is never told that a service they receive is delivered by another provider not in their insurance network, the commissioner 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 Wolf Administration are committed to ensuring consumers and patients do not have the added shock of a large, unexpected medical bill.”

Miller cited one common example where a consumer goes to an in-network hospital for a planned surgical procedure. The consumer may even have verified that their surgeon is in their health plan network, but is not informed that another provider assisting in their procedure is not in-network. These consumers are often taken completely by surprise when they receive balance bills for the out of network provider’s services, bills that are often difficult to afford, said Miller.

“These patients made an assumption that many would – if the hospital is in-network, then the doctors and other health care professionals working there are in-network, too,” said Miller. “This is not always the case, 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 will seek to shed light on the problem of balance billing within Pennsylvania. She said the hearing will also be 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 some possible consumer-friendly solutions to the issue. Miller said she believes this hearing will be a substantive first step in tackling the issue of balance billing.

The Pennsylvania Insurance Department announced that affected consumers and interested parties are all invited to testify at the hearing, which will be held on Oct. 1, from 10 a.m. to 1 p.m., in the auditorium of the State Museum, 300 North Street, Harrisburg, and is open to the public. Written testimony may be submitted by emailing the Insurance Department’s Consumer Liaison David Buono, at dbuono@pa.gov. The hearing will also be live-streamed at http://pacast.com/players/live_insurance.asp.

Source: The Pennsylvania Insurance Department

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