The Lead

Advocates ask lawmakers ‘to act quickly, act now’ on surprise medical bill legislation

By: - April 15, 2020 11:50 am

(Photo by cafecredit)

Unable to rally in Harrisburg, healthcare advocates organized via Zoom webinar Wednesday to share the stories of Pennsylvanians affected by surprise medical bills. 

Hosted by Pennsylvania Health Access Network, advocates offered their “enthusiasm” for the consumer protections in a plan now before the state House that would eliminate surprise medical bills for Pennsylvanians. The bill, HB1862, sponsored by Rep. Tina Prickett, R-Bradford, was approved by the House Insurance Committee last fall, and is awaiting a floor vote. 

The bill, they said, is now more important than ever as the state grapples with COVID-19. 

“In the midst of a public health care crisis the last thing folks should have to worry about is a surprise medical bill.” Antoinette Kraus, Executive Director, PA Health Access Network said. 

In a memo seeking support for her proposal, Pickett said her bill would, if approved:

  • “Ensure that consumers are only responsible for their in-network cost-sharing obligations.
  • “Instruct providers to bill insurers directly, while also allowing consumers to trigger protections if they do receive a balance bill.
  • “Instruct insurers to negotiate with providers to determine fair payment for the services that consumers receive.”

Kraus said that while lawmakers and state officials agree that patients shouldn’t receive a surprise medical bill for COVID-19 care, there is no legal protection to guarantee that. 

Another concern expressed by PHAN advocates is the lengthy and often tedious appeals process to resolve surprise medical bills. 

“Individuals have few, if any choices to resolve surprise medical bills,” Kraus said. 

Bill England was one Pennsylvanian to share his story of a surprise medical bill with virtual attendees Wednesday. 

Last year, England woke up one morning with chest pains. After trying to go about his morning routine, England decided the pain required medical attention from ano urgent care in his network of providers. Urgent care staff  told him to go to the emergency room after tests were inconclusive.

England again, went to a hospital in his network of providers. At the hospital, doctors were able to determine that England was not having a heart attack or other cardiac episode, but a strain on a chest muscle in the area of his heart.

Relieved, England returned home and to his routine. 

A few weeks later, bills started to arrive. One radiology bill totaled $375 because the radiologist reading his test results was out of network, despite the fact that the urgent care facility and the hospital he sought out for care were in his network. 

“I’m not going to stop in the middle of treatment and ask for credentials, England said. “I know that this is a real issue for a growing number of people.”

Grateful to be in a position to be able to afford his surprise medical bills, England expressed concern for those who cannot. 

“I am really encouraging our state to take action with this basic consumer protection,” England said. 

While surprise medical bills can be the result of any type of medical care, Kraus said surprise bills are most often incurred in specialist care, tests, anesthesiology, and women’s health care. 

Although the House bill  does not include provisions for arbitration included in similar legislation in states such as New York, Kraus said that’s a plus for consumers because arbitration often incurs further costs through higher out-of-network care

“This bill is a strong balance between consumers and health plans,” Kraus said.

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Cassie Miller
Cassie Miller

A native Pennsylvanian, Cassie Miller worked for various publications across the Midstate before joining the team at the Pennsylvania Capital-Star. In her previous roles, she has covered everything from local sports to the financial services industry.