The Lead

New federal law will help protect Pa. residents against surprise medical bills, Wolf admin says

By: - January 13, 2022 2:43 pm

Federal protections against surprise medical bills are now in effect, the commonwealth’s top insurance official reminded Pennsylvanians Thursday.

“The implementation of the No Surprises Act is a huge step toward ending unexpected and all-too-often financially devastating medical bills,” Insurance Department Commissioner Jessica Altman said. 

The newly enacted federal law took effect on Jan. 1. It prevents patients from receiving surprise medical bills by “requiring that emergency services are billed as in-network, without needing prior approval” and by banning specific “out-of-network charges and balance billing without advance notice,” according to the department

The law also requires that health care providers supply patients with a plain-language notice of consent for care before billing for care received by an out-of-network provider. 

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One in three insured adults ages 18-64 say their family has had a surprise medical bill, according to February 2020 data from the Kaiser Family Foundation, a national nonprofit focused on health issues.

The same poll found that 65 percent of Americans were “very worried” (35 percent) or “somewhat worried” (30 percent) about being able to afford unexpected medical bills. 

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

The No Surprises Act covers individuals on employer-sponsored insurance, on coverage purchased through Pennie, the state’s insurance marketplace, and on individual market health insurance company plans. 

Individuals covered by Medicaid and Medical Assistance plans already have billing protections in place, the department said. 

The No Surprises Act, was passed by Congress in December of 2020 as part of the Consolidated Appropriations Act.

Last month, Gov. Tom Wolf designated the Pennsylvania Insurance Department as the overseeing entity for implementing the new protections in the commonwealth. 

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“The Insurance Department is committed to protecting patients from balance billing and stands ready to assist consumers and insurers in navigating this new legislation,” Altman said. 

PID encourages Pennsylvanians who receive a surprise medical bill in the new year to submit it to the department for further review. 

The department’s dedicated consumer complaints team will verify the type of coverage the patient has and will reach out directly to the provider regarding the bill in question with the primary goal of ensuring the protections of the No Surprises Act are being met,” a statement from the department reads. 

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