After months studying a growing balance billing problem, Pennsylvania Insurance Commissioner Teresa D. Miller suggests patients should be removed from the dispute.
In a public comment period that ends Feb. 29, Miller proposed Tuesday that insurance companies and health care providers go to arbitration when they cannot reach an agreement.
Miller’s proposal would require state legislation.
“When we held the public hearing, we didn’t know what the solution was going to look like,” Miller said in a phone interview Tuesday. “While we may have had an administrative solution, there really isn’t a very clean way to address this absent legislation.”
A balance bill happens when a doctor group – radiologists, anesthesiologists or ER doctors – charge above what an insurance company has agreed to pay. Although patients select a primary care doctor, they seldom choose these specialists.
Both local hospitals contract with a single provider that does not accept all the insurance plans the hospitals do.
“We remain firm in our belief that balanced billing is an issue that independent physicians/physician groups and insurers need to address,” Mike Jupina, a Penn State Health St. Joseph spokesman, said in an email to the Reading Eagle. “It appears as if the (proposed) legislation is moving in that direction.”
Attempts to reach Jessica Bezler, a Reading Health System spokeswoman, were unsuccessful.
It’s an issue not isolated to Pennsylvania. Legislatures in New York, Colorado and Texas have all corrected, to varying degrees, the problem.”At the end of the day this was really our own unique solution,” Miller said of the proposed legislation.
Miller held a public hearing on the matter in Harrisburg in October.
The Reading Eagle first raised the issue in March after a local insurance agent complained his clients were being billed for mammogram screenings from both radiology groups.
In July, state Sen. Judy Schwank and U.S. Sen. Bob Casey Jr. wrote letters to state and federal departments with oversight looking for possible fixes to the problem at the request of Jay Mahoney, an insurance agent with Gallen Insurance in Cumru Township.
Schwank said Miller’s proposal strikes a good balance that she could support.
“We have an insurance commissioner in our corner,” the Ruscombmanor Township Democrat said.
She added, “This gives us just one more leverage point in getting something done.”
Under the Affordable Care Act, mammogram screenings are supposed to be without a co-pay or deductible, if done in network. The intent was to foster early detection because research shows this can improve and save lives by identifying and treating illnesses before it develops into a more complicated and debilitating condition.
“It’s going to eliminate people from having to pay for something they shouldn’t have to pay for,” said Mahoney, who described the proposal as a win for patients. “It’s not confrontational. I think working it out this way is the right way to handle the situation.”
The Consumer Reports National Research Center last year found nearly one in three privately insured Americans have received a surprise medical bill in the past years.
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Photo courtesy of: Reading Eagle
Originally Published On: Reading Eagle
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