Pennsylvania insurance commissioner targets surprise bills from out-of-network doctors

The Pennsylvania Insurance Commissioner was the latest state official to propose protections for healthcare consumers against surprise balance bills. Surprise balance bills occur when a consumer receives emergency care, or has made a good-faith effort to use providers and facilities in their insurance network, but unexpectedly receives a service from an out-of-network provider or facility, then receives a bill. The goal of the proposal is to take consumers out of billing disputes between insurers and providers. The department is looking to work collaboratively with the General Assembly, consumers, and stakeholder groups to draft legislation on the issue. The plan would protect consumers who seek healthcare at in-network facilities, or from in-network providers, from being billed by an out-of-network provider at a cost more than what they would owe to a provider for any in-network cost sharing under the consumer’s health plan.