HARRISBURG, Oct. 1, 2015 – With many Pennsylvanians suffering “sticker shock” when they get a bill for medical procedures they believed their insurance company would cover, state Sen. Judy Schwank today urged the commonwealth to stop the practice of so-called “balance billing.”
The Berks County Democrat testified Thursday morning during a special state Insurance Department public hearing on the issue.
“Situations like this have every appearance of bait-and-switch and that is just part of the problem balance billing poses,” Schwank testified. “These debts are not just hidden, they are almost impossible for the typical health care consumer to discover beforehand.”
Balance billing is when a consumer is billed unexpectedly for a difference between the provider’s charge and the payment allowed by the insurer. It is especially a problem when patients are billed after services are provided outside their insurer’s networks without the patient being aware of it.
“The passage of the Affordable Care Act was good news for millions of men and women because screenings for breast cancer, colon cancer and other diseases – where early detection is vital – are now covered in every insurance policy without a co-pay or deductible,” Schwank said.
“Imagine the shock when someone who finally has insurance, uses it for a health screening they put off too long because of their concerns about being able to afford it, and then gets a bill for the screening they might not be easily able to afford.”
Pennsylvania Insurance Commissioner Teresa Miller, who has expressed similar concerns as Sen. Schwank, called today’s public hearing on balance billing.
“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,” Miller has said publicly. “In many instances, the patient only finds this out when they get a bill for the amount not covered by insurance.”
Schwank said Berks County residents are blessed to have two excellent hospitals, but even with them, balance billing is hurting many health care consumers.
“Earlier this year I learned through an insurance broker that a number of women who went to them for mammograms had been balance-billed,” the senator testified. “It turned out that that the radiologists working at the hospital were not hospital employees, but were employees of a private practice that served both hospitals and was outside the women’s insurance networks.”
Schwank said balance billing is not fair in these cases because the details of which specialist is employed by which health care provider is practically impossible to figure out.
She said she will work with the department to achieve appropriate legislative or administrative changes.
“Whether we use an ‘assignment of benefits’ process, such as New York enacted earlier this year, a dispute resolution board or some other method, patients deserve to know beforehand whether they will be personally responsible for their care costs,” Sen. Schwank testified.
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