June 23, 2020

Insurance Department Issues Notice to Insurers Highlighting Inappropriate Billing Practices

Harrisburg, PA – Insurance Commissioner Jessica Altman announced today that the department has submitted a notice to the Pennsylvania Bulletin outlining guidance for insurers that encounter providers engaging in inappropriate billing practices during the COVID-19 pandemic. 

“The department has recently been made aware of new COVID-related fees that providers, particularly dental providers, may be charging patients outside of the insurer-provider contract,” said Altman. “While some of these fees may be appropriate, others may be counter to the terms of the contract between an insurer and a provider, which often contain provisions intended to protect consumers from extra costs and fees. We encourage insurers to examine their provider contracts and address these new fees with providers in accordance with the contractual obligations of the provider or report such practices to the Office of Attorney General. Consumers should not be held responsible for fees that are prohibited or otherwise accommodated for as part of the insurer-provider relationship.” 

Commissioner Altman continued, “The department has also been hearing about egregious bills, particularly for lab services, related to COVID-19. These stories really amplify the need for surprise billing protections for consumers. Whether that happens in Washington or within our own state legislature, policymakers must ensure that patients are held harmless in surprise billing situations. Our notice cautions against improper price gouging and lets consumers and carriers know that Commonwealth offices are here to help protect consumers against such abuses.” 

The notice announced today is issued as a continuation of Notice 2020-03, issued March 21, 2020, which urged health insurers to help consumers avoid balance billing and surprise balance bills. The notice also recommended health insurers make all necessary and useful information available on their websites, or through consumer assistance lines, in an effort to provide readily available accurate information for insureds during the ongoing coronavirus (COVID-19) pandemic.

The COVID-19 Surprise Bill notice encourages health insurers to continue with guidance issued in previous notices, and encourages companies and agencies to be aware of new potential billing issues that have arisen in context of the continuing pandemic.

The department also encourages health insurers to alert consumers to the potential for these improper billing practices through communication on their website or consumer assistance lines, so they are empowered to lodge a complaint with either the insurer or the Office of Attorney General.

The department has submitted various notices to the Pennsylvania Bulletin to help ease the hardships that are being felt by Pennsylvanians during this crisis and ensure minimum disruption to the department and commonwealth-regulated operations.

If a consumer receives an unexpected bill related to COVID-19, or other healthcare services, they are encouraged to contact the department at 1-877-881-6388.

Visit the commonwealth’s Responding to COVID-19 guide for the latest guidance and resources for Pennsylvanians or the Pennsylvania Department of Health’s dedicated coronavirus webpage for the most up-to-date information regarding COVID-19. 

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