Governor Wolf has taken action against “surprise bills.”
The federal No Surprises Act was implemented to protect patients from receiving surprise medical bills.
Governor Tom Wolf was joined on Monday by the Pennsylvania Insurance Department (PID), stakeholders, and a consumer who has fallen victim to surprise billing to celebrate the upcoming implementation of the federal No Surprises Act on January 1, 2022.
“A patient who has carefully researched and selected an in-network facility and provider or is seeking care because of an emergency should not be stuck with out-of-network costs and billing when they had little or no choice regarding providers that may, in the end, be out -of-network,” said Gov. Wolf. “The Wolf Administration has been committed to protecting consumers from balance billing, and the implementation of the No Surprises Act is a major step toward ending unexpected, upsetting and many times financially devastating medical bills.”
A surprise bill is an unexpected medical bill that a patient receives when they unintentionally receive health care from a provider that is outside their plan’s provider network. Surprise bills can happen in emergency situations, but can also occur in a non-emergency situation.
The No Surprises Act will protect patients from surprise bills by requiring that emergency services are billed as in-network, without needing prior approval. Certain non-emergency services at an in-network facility provided by out-of-network providers are also covered as in-network.
Also, the No Surprises Act will ban other out-of-network charges and balance billing without advance notice.
Governor Wolf signed an executive order Monday, designating the Pennsylvania Insurance Department (PID) as the lead agency to coordinate implementation of the No Surprises Act in the Commonwealth.
Patients who receive a surprise medical bill for services provided on or after January 1, 2022 should contact the Insurance Department at www.insurance.pa.gov/NoSurprises with any questions or to file a complaint. They can also seek assistance from their health plan.
“The Insurance Department has received numerous complaints about surprise bills over the past few years,” said Insurance Commissioner Jessica Altman. “Our medical system is complicated enough. The primary concern following major medical procedures should be recovery, not worry over medical billing. My department stands ready to implement this new legislation and protect consumers who act in good faith.”
The No Surprises Act will protect consumers with coverage through their employer, Pennie (Pennsylvania’s state-based Marketplace), or directly through an individual market health insurance company. It does not apply to consumers with Medicare, Medicaid, CHIP, or Tricare; as these programs already have their own balance billing protections. It also does not apply surprise medical bill protection to consumers who have short-term or other limited benefit coverage. However, those consumers and uninsured individuals will now be able to get an estimate of the charge for a medical service ahead of receiving care, and the law provides a process to challenge a bill that is substantially in excess of that estimate.
Anyone with questions on the No Surprises Act or surprise bills is asked to contact the Insurance Department at www.insurance.pa.gov/NoSurprises or 1-877-881-6388.