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Insurance Commissioner Announces Proposed Solution to Protect Health Care Consumers from Surprise Balance Bills; Asks for Public Comment


Harrisburg, PA - Insurance Commissioner Teresa Miller today announced a proposed solution to protect health care consumers from surprise balance bills and is soliciting public comment on the proposal.  Surprise balance bills happen when a consumer receives emergency care or has made a good faith effort to use health care providers and facilities in the consumer’s health insurance network, but has unexpectedly received a service from a provider or at a facility that is out-of-network, then receives a bill for that service.

“At a public hearing in October, I heard from consumers who, despite their best efforts to use providers in their health insurance network, still received out-of-network bills that were in the hundreds -- and in some cases thousands -- of dollars,” Commissioner Miller said.  “My department has taken the information gathered at that hearing and is now offering for comment the proposed solution being announced today.”

The goal of this proposal is to take consumers out of billing disputes between insurers and health care providers. In order to meet this goal, the Department is looking forward to working collaboratively with the General Assembly, consumers, and stakeholder groups to draft legislation on this issue.

“As I said at the public hearing, when an individual is faced with a major medical issue, that person needs to concentrate on getting well, and not worry about whether an unexpected medical bill is coming in tomorrow’s mail,” Commissioner Miller said.

The proposed plan would protect consumers who seek health care at in-network facilities, or from in-network providers, from being billed by an out-of-network provider at a cost more than what they would owe to a provider for any in-network cost sharing under the consumer’s health plan. For example, if a consumer’s health insurance plan has a $50 co-pay for a certain service delivered by an in-network provider, that consumer could not be liable for more than $50 for that same service from an out-of-network provider.

The proposal provides several options for insurers and health care providers to reach agreement on payment. If the provider and insurer cannot reach an agreement on payment, the matter would go to arbitration. Both sides would submit their offers with supporting documentation, and the arbitrator’s decision would be binding. In no case would the consumer be liable for anything beyond the cost-sharing due for the service if it had been rendered by an in-network provider.

“The open comment process is in line with Governor Wolf’s pledge of open and transparent government,” said Commissioner Miller. “This also allows the Department to get input from various stakeholders, including insurers, hospitals, and health care providers, all of whom also testified at the Insurance Department’s public hearing on this topic in October.” 

A link to the proposed solution and information on how to offer comments can be found at, by clicking on “Proposed Balance Billing Solution”.  The deadline for offering comments is February 29, 2016.

A link to the public hearing on surprise balance bills is available at, by clicking on “Public Hearing Archive” under Top Pages

MEDIA CONTACT: Ron Ruman - 717-787-3289

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