Legislation to end ‘surprise medical billing’ draws insurance department support
A “surprise” medical bill is when someone goes to an in-network health care provider but gets billed for services the provider contracted out of network. (File)
“Surprise medical billing” is a term for when someone goes to a health care provider in their insurance network, but gets billed because someone outside of the network was contracted for some services.
Two proposals in the state legislature are designed to protect patients from receiving those bills. The legislative efforts have picked up support from state Insurance Commissioner Jessica Altman, who says her office gets a lot of complaints from people who sought out an in-network hospital or surgery facility, only to get stuck paying hundreds, and occasionally thousands, of dollars.
It’s a common problem, Altman said. People go to a hospital or doctor in their network, only to receive an “out of network” bill for services like anaesthesia or bloodwork.
It’s been a problem for years, but narrower networks and higher deductibles have made it more noticeable, Altman said.
Most cases involve bills in the hundreds of dollars, but they occasionally can be much higher.
“We saw a case in Southeastern Pennsylvania where a woman gave birth to hear child quite prematurely and all of the neonatal care she received at an in network hospital were by an out of network provider, and she received a bill for $80,000 dollars for those services,” Altman said.
Democratic State Senator Judy Schwank of Berks County, who sponsors one of the bills, said the effort is picking up bipartisan support, and lawmakers are working with stakeholders to work out the details.
Paula Bussard of the Hospital and Health System Association said the health care industry supports making sure people don’t get stuck paying for out-of-network services, as long as they were performed at an in-network facility. The industry is working with lawmakers to make sure the insurer and provider are able to negotiate together on how to pay for the remaining costs, Bussard said.
One part of the measure would prevent out-of-network billing for when someone goes to an out-of-network hospital for an emergency.
Altman said those who receive a surprise bill should call their insurance company, and if that doesn’t work, call her department.
