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Health, Science & Tech

Surprise Balance Billing Probed By State


A problem that has cost thousands of Pennsylvanians hundreds, if not thousands, of dollar has the state investigating.

Insurance holders think they have found an in-network provider for a specific procedure, but a physician, specialist or contractor who is out-of-network is actually helping to provide the care. The result is a bill that the patient thought would be $50 dollars, turns into a bill for much more.

It’s called surprise balance billing.

Many times, without advance warning, such providers separately bill patients for hundreds, even thousands of dollars of services, and insurance rarely covers the cost.  At a recent hearing held by the state Insurance Department, Jay Mahoney, an insurance broker in Berks County, says he’s dealt with at least 150 of these cases in the past couple years.

Mahoney said the issue‘s led to frustration, confusion and unnecessary costs for consumers and the health care system.

State Insurance Commissioner Theresa Miller says she’ll use information from the hearing to put together some solutions.