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Narrow Networks/Any Willing Provider/Out-of-Network Billing

Description-iconProtecting patients from out-of-network health care billings must start with fixing the root cause of the problem – tiered and narrow health insurance provider networks and a lack of insurance product transparency.

Current-Legislation-iconCurrent Legislation:
PAMED supports HB 602, which would prohibit a health insurer from excluding any provider in its geographic area who is willing to meet its conditions of participation.

  • PAMED opposes HB 130, which would prohibit an out-of-network provider who renders mental health care, substance disorder treatment, or a treatment for a disability, from billing an eligible insured for any amount in excess of the cost-sharing amounts that otherwise would have been imposed.

  • PAMED opposes SB 822, which would allow the arbitrator to use Medicare rates when issuing a decision in the out-of-network dispute resolution process between the insurer and the physician.

 

 

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PAMED Position
 Patients should have access to health care choices. PAMED supports patient choice and advocates against anything that may interfere with that.

Pennsylvania physicians should be reimbursed fairly, regardless of network status.

Status-icon

Status 
 PAMED reviewed draft out-of-network billing legislation and provided input.

HB 602 awaits consideration by the House Insurance Committee.

HB 130 awaits consideration by the House Insurance Committee.

SB 822 awaits consideration by the Senate Banking and Insurance Committee.

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How it Affects You
 In order to contain costs, insurers are narrowing provider networks, which results in further shifting costs to patients. Patients are realizing that they are financially responsible for health care costs that they thought would have been covered by their insurance plan. Patients can’t be expected to discern the network or contract status of hospital-based physicians when seeking services at an in-network hospital. When patients get surprise bills, they often call their physician’s office. PAMED also believes that Pennsylvania physicians should be reimbursed fairly, regardless of network status.

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What is PAMED Doing About it?
PAMED continues to participate in monthly Provider Coalition meetings to advance legislation and strengthen communications between stakeholders. The Provider Coalition strongly encourages the House Insurance Committee to hold a future hearing on network adequacy requirements and potential updates to the outdated law.

In addition to state efforts, PAMED is working to support the American Medical Association (AMA) on the federal level to address out-of-network billing. On July 10, 2019, the AMA sent a letter to the Committee on Energy and Commerce’s leadership. PAMED signed onto this letter. You can read it here.

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What Action Should I Take?
Contact your state representative and senator to encourage them to support HB 602 and oppose HB 130 and SB 822. You can find your legislator’s contact information at http://cqrcengage.com/pamed/Lookup.

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