Several states, including Texas, New York, Pennsylvania and Florida, have recently pursued measures to shield consumers from surprise medical bills for out-of-network medical care.
The surprise bills stem from "balance billing," or when patients are charged the difference between the provider's charge and the payer's reimbursement. The issue often comes into play when a patient goes to an in-network hospital, but is treated by an out-of-network provider.
According to the Kaiser Family Foundation, about a quarter of states have restrictions in place to protect patients from out-of-network balance billing. Here is a break down the most recent actions taken by states.
Florida
Florida Insurance Consumer Advocate Sha'Ron James is calling a forum Oct. 15 to gather input on surprise medical billing to inform state legislation in the upcoming session, according to The Palm Beach Post.
Pennsylvania
Pennsylvania Insurance Commissioner Teresa Miller held a public hearing Oct. 1 on balance billing to gather information and input to find a solution to the issue. "We must work to find a way to protect consumers from these bills," Commissioner Miller said at the hearing. "When someone undergoes a major medical procedure, they need to focus on their recovery, not an unexpected fee."
Texas
A measure went into effect Sept. 1 allows patients to challenge surprise out-of-network medical bills if they are greater than $500. Previously, consumers could only challenge bills over $1,000.
New York
New York's law went into effect March 31 that caps patients' surprise out-of-network bills at their in-network copayment, coinsurance or deductible. Under the law, uninsured or self-insured patients can dispute the bill if they were not given sufficient information.
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