Pennsylvania Insurance Commissioner Announces Public Hearing on Surprise Balance Billing of Health Insurance Consumers

HARRISBURG, Pa., Sept. 8, 2015 /PRNewswire-USNewswire/ -- Insurance Commissioner Teresa Miller today announced that her department will hold a public hearing on the issue of balance billing. 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. Commissioner Miller is particularly concerned about cases where a consumer uses out-of-network emergency care or seeks care at a facility in their health plan's network, but receives certain services from an out-of-network provider for which they receive a surprise bill.

"It is critical that we address this issue in order to protect consumers from getting an unexpected bill from a provider," said Commissioner Miller. "When someone faces a health issue such as surgery, treatment in an emergency room, or even a routine procedure, they should be free from worrying about facing financial hardship once they return home."

Miller said 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. 

"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. In many instances, the patient only finds this out when they get a bill for the amount not covered by insurance," Miller said. "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.

"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 the Commonwealth.  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 believes this hearing will be a substantive first step in tackling the issue of balance billing, and giving consumers more peace of mind and predictability in coverage.

Affected consumers and interested parties are all invited to testify at the hearing. The hearing will be held Thursday, 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 [email protected].  The hearing will also be live-streamed at http://pacast.com/players/live_insurance.asp.

MEDIA CONTACT: Ron Ruman, Insurance Department, 717-787-3289

SOURCE Pennsylvania Department of Insurance

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