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Each legislative session thousands of bills and amendments are introduced in the Pennsylvania Legislature. Only a fraction become law, and an even smaller portion receive wide media coverage.

These bills impact the lives of people living in Pennsylvania every day.

Each week The Sentinel will highlight one bill that has not received widespread attention.

About the bill

Something unexpected happens. You get sick and go to the hospital.

The hospital is in-network and you pay the co-pay and head home, only to be later greeted by a bill for services performed by an out-of-network physician at the in-network hospital.

A bill introduced by Rep. Matthew Baker, R-Bradford County, and Rep. Tina Pickett, R-Bradford County, is aimed at limiting these “surprise balance bills.”

“Surprise balance billing happens when someone gets medical care from providers and at facilities they believe are in their health insurance plan’s network, but unknowingly receives services from an out-of-network provider,” the two wrote in a co-sponsorship letter for House Bill 1553. “Surprise balance billing can also occur following an emergency, when a consumer has little or no control over where they are taken to receive care, and are often taken to an out-of-network emergency room.”

In the co-sponsorship letter, Baker and Pickett provide examples of a State College resident being billed more than $2,000 for blood work drawn at an in-network facility but that was sent to an out-network facility for analysis.

They also cite a constituent in Lancaster who had surgery done at an in-network hospital by an in-network surgeon, but who received a $1,300 bill because the anesthesiologist was out-of-network.

Among its provisions, the “Surprise Balance Bill Protection Act” requires out-of-network providers working in in-network facilities to bill consumers no more than what an in-network provider would.

It would also prohibit out-of-network providers from sending these “surprise balance bills” to collection agencies.

Email Joshua Vaughn at Follow him on Twitter at @Sentinel_Vaughn.


Cops & Courts Reporter

Crime & Courts Reporter at The Sentinel.

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