House Insurance Committee approves legislation to protect consumers from surprise medical balance bills

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The state House Insurance Committee recently approved legislation sponsored by Rep. Tina Pickett (R-Bradford/Sullivan/Susquehanna) that aims to protect consumers from surprise medical balance bills.

Pickett explained in a press release that surprise balance billing occurs when an individual receives medical care from a provider they believe is in their health insurance plan’s network, but the services come from an out-of-network provider. This can also occur after an accident when a patient is taken to an out-of-network emergency room, Pickett noted.

“We’ve heard of a number of such cases around the state, including a patient who was billed over $2,000 for blood tests that were taken at an in-network hospital by an in-network doctor but sent for analysis at an out-of-network lab,” Pickett said. “In another case, a patient had surgery at an in-network hospital performed by an in-network surgeon but was billed $1,300 for services provided by an out-of-network anesthesiologist. You can imagine their shock when those bills arrived in the mail.”

Specifically, House Bill 1862, also called the Surprise Balance Bill Protection Act, aims to ensure consumers are only responsible for their in-network cost-sharing obligations. It would also instruct providers to bill insurers directly, allow consumers to trigger protections if they receive a balance bill, and instruct insurers to negotiate with providers to determine fair payment for services.

House Bill 1862 now heads to the full House for consideration.