Surprise billing legislation stalls again on East Coast

Legislation designed to protect consumers against emergency out-of-network medical bills has hit a wall in Pennsylvania, Rhode Island and New Jersey.

This month, Rhode Island and Pennsylvania legislators tabled bills which required their respective state insurance commissioners to establish a dispute-resolution process for consumer bills arising from involuntary out-of-network medical care.

Rhode Island Bill 1158, introduced by Rep. Robert Craven Sr. (D-North Kingstown), would have given patients an opportunity to dispute out-of-network bills through arbitration. But Health Insurance Commissioner Kathleen Hittner, MD, argued the bill should assert stronger controls.

"We need to do much more than just provide a dispute process — we need to go much further in managing this process," Dr. Hittner said in a letter to House Corporations Committee Chairman Brian Kennedy.

In Pennsylvania, senators killed a bill that removed the patient from the dispute entirely and required insurers and healthcare providers to settle involuntary out-of-network bills through arbitration.   

Each bills' respective sponsors said they intend to reintroduce balance billing legislation in state congress next year.

Controversial billing legislation also stalled in New Jersey this fall. Current laws prohibit insurers from billing patients for extra costs associated with involuntary out-of-network care.

The proposed Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act limited the amount hospitals could bill insurance companies for involuntary out-of-network care to between 90 percent and 250 percent of the corresponding Medicare payment rate. This essentially prohibited providers from billing patients for the difference between the insurer's in-network payment rate and the provider's out-of-network charge.

New Jersey Bill A1952 was one of the most-lobbied bills in the last legislative session.

So far, five states have enacted laws to protect against or prohibit balance billing practices, including Illinois, California, Connecticut, Florida and New York.



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