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Insurance Commissioner reminds Pennsylvanians of increased consumer protection against unforeseen medical bills

Pennsylvania Pressroom

HaveUnsurprisingly federal law is now in effect

Harrisburg, Pennsylvania – Pennsylvania Insurance Commissioner Jessica Altman reminded Pennsylvanians today that federal No Surprises Act is now in effect and patients are protected from surprise medical bills.

A surprise bill is an unexpected medical bill that a patient receives when they unwittingly or inadvertently obtain health care from a provider who is not part of their plan’s provider network. Surprise bills can occur in emergency situations, but can also occur in a non-emergency situation, when an off-grid auxiliary provider, such as an anesthesiologist or radiologist, provides care at a network facility.

“The implementation of the No Surprises Act is a big step towards ending unexpected and too often financially devastating medical bills,” said Altman. “The Insurance Department is committed to protecting patients from balance billing and stands ready to help consumers and insurers navigate this new law. “

The No Surprises law came into force on January 1. The new legislation protects patients against surprise bills by requiring that emergency services be billed over a network, without prior approval, and certain non-emergency services in a networked facility provided by Network ancillary providers are also covered as network. In either case, patients are only responsible for their sharing of costs across the network (such as a deductible or co-payment) for the service. Patients should no longer receive surprise balance bills for more than this amount.

“Over the past few years, the insurance department has received numerous complaints about surprise invoices,” said Altman. “The primary concern following major medical procedures should be recovery, not the worry of medical billing.

“While the monetary cost of surprise balance bills is heavy, so too is the fact that prior to these new protections, consumers were placed in the middle and forced to navigate the intricacies of medical billing in search of a stay, ”Altman continued. . “Which happens sometimes, but too often doesn’t.”

In addition, the No Surprises Act prohibits certain other off-grid charges and the billing of the balance without notice. Healthcare providers and institutions are required to provide consumers with a plain language consumer notice explaining that patient consent is required to obtain out-of-network care before that provider can bill the consumer.

In December, Governor Tom Wolf signed an executive order designating the Pennsylvania Insurance Department as the lead agency to coordinate the implementation of the No Surprises Act in the Commonwealth. The executive order also ordered Pennsylvania state agencies to provide assistance and encouraged interagency cooperation in implementing the new federal legislation.

The No Surprises Act protects individuals with coverage through their employer, Pennie ™ (Pennsylvania State Market), or directly through an individual market health insurance company. Other types of coverage, such as Medicare and Medical Assistance, already have protections in place against billing the balance before January 1.

Patients who receive a surprise medical bill for services provided on or after January 1, 2022 should submit a bill review request to the Insurance Department at www.insurance.pa.gov/NoSurprises. Whenever possible, consumers should contact the Department before paying a bill that they believe to be a surprise or erroneous bill. The department’s dedicated consumer complaints team will verify the patient’s type of coverage and contact the provider directly about the bill in question with the primary purpose of ensuring that the protections of the No Surprises Act are met. Depending on the nature of the complaint, the department may need to work with the federal government or another Commonwealth agency to help resolve the issue for the patient. Patients can also seek help with their health plan.

The Pennsylvania Insurance Department encourages patients to contact the service before paying a bill that they believe was sent in error or appears to not comply with the No Surprises Act. In addition to the website, the service can also be reached at 1-877-881-6388

CONTACT WITH THE MEDIA: Thaisa Jones, thajones@pa.gov

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