Pa. looking at why some people get surprise health care bills
Photo by Ben Allen/witf
Pennsylvania Insurance Commissioner Theresa Miller (center) listens as people testify at a recent hearing on surprise balance bills.
(Harrisburg) — The reading of a radiology scan – $130.
A neonatologist pulled in to help – $793.
A surgeon who performed open-heart surgery – $32,000.
Imagine going to an in-network hospital, and walking out with a bill for hundreds or thousands of dollars for services that are supposed to be covered. Pennsylvania’s now scrutinizing this practice, called surprise balance billing.
The above examples are just some that were offered at a recent state hearing.
Patients went to an in-network hospital or provider, and ended up with costly bills because a contractor was out-of-network – and they had no idea.
Berks County insurance broker Jay Mahoney says without telling patients, one hospital sends breast screenings to an outside provider, which then bills people if they’re not in-network for their insurance.
“That itself is going to stop women from going to get their mammograms. Which if caught early, breast cancer can be treated and eliminated. And to me that’s egregious,” says Mahoney.
He says for those who get treatment at Reading Hospital, they also often face bills from a contractor. “In many cases, there should be no additional charge for the imaging performed at Reading Hospital on behalf of their patients. The question is how many patients have paid that I’m not aware of, unnecessarily for these services to West Reading Radiology.”
Mahoney says he’s dealt with at least 150 of these cases in the past couple years.
State Insurance Commissioner Theresa Miller says she’ll gather information before coming up with regulations.
Some states, including Connecticut and Texas, have started to restrict balance billing, with mixed results.
Experts point to New York as a state that is trying to aggressively address the issue with a law that went into effect in April, but they also say it’s too early to say what kind of effect it will have.
Editor’s note: Ben Allen covered this issue in March, and found that in many midstate hospitals, ER doctors are not hospital staff.
