Pennsylvania’s Surprise Balance Billing Protection Act, HB 1862, bill passed out of committee unanimously, and is now sitting on the House floor, waiting for second consideration. The bill keeps consumers stay out of the middle of this issue in an emergency situation by allowing them to pay the expected in-network rate. In this bill, out of network providers would be paid a median, in-network rate that’s adjusted for region and specialty. This is known as a “benchmark rate”.

Leadership in the PA House is continuing to work on the bill and has a strong interest in moving it forward, and leadership in the PA Senate is interested in receiving the House bill once it passes the House. The COVID-19 crisis is shedding more light on this issue as consumers begin to get tested and treated for the virus. Surprise medical billing is a bipartisan issue across the country.

Surprise medical bills are alarmingly common in Pennsylvania. A 2018 study found that 1 in 3 Pennsylvania adults has received a surprise medical bill over the past year, and most of them don’t know where to turn to get help. Not sure what a surprise medical bill is? See the graphic, prepared by the Pennsylvania Health Access Network (PHAN).

Surprise medical bills often happen following an emergency, like a heart attack or serious car accident, when patients don’t have the chance to choose who provides their care. Surprise medical bills can also happen at an in-network hospital when some of the providers who care for a patient are not in the network or when an in-network provider refers a patient to get lab work, a diagnostic test, or other care that isn’t in-network. Typical bills can range from a few hundred dollars to thousands of dollars.
Surprise medical bills can financially devastate families and individuals who receive them.

A 2016 Federal Reserve study found that 44% of U.S. households cannot pay an emergency expense of $400 or more without borrowing or selling some of their possessions, and a 2018 poll conducted by the Kaiser Family Foundation found that 67 percent of people nationwide are worried that they won’t be able to afford a surprise medical bill. That ranks higher among people’s worries than being unable to pay for prescription drugs, health insurance premiums or deductibles, or for basic expenses such as food, rent, mortgage and gas.

Currently, Pennsylvania law does not adequately protect patients from getting hit with surprise medical bills when they receive care from an out-of-network provider. Patients need protections from surprise medical bills, but it must be done in a way that doesn’t increase premiums or reduce patients’ access to doctors. If the solution were to make our insurance plans pay out-of-network providers too much, then out-of-pocket costs go up for everyone.