The Pennsylvania Insurance Department issued a warning to health insurers, stating that consumers will not have to pay out-of-network costs if the carrier’s provider directory is out of date.
The following is the statement from Insurance Commissioner Teresa Miller:
Insurance Commissioner Continues Consumer Protection Push, Says Consumers Will Not Have to Pay Out-of-Network Costs If Insurer’s Provider Directory Is Out of Date
Pennsylvania Insurance Commissioner Teresa Miller reminded insurers that they must keep their provider directories up to date and that consumers should not pay higher out-of-network costs if they use a health care provider who is out-of-network but, at the time the service was provided, was listed in their insurer’s provider directory as in-network.
Teresa Miller
“Governor Wolf and I are working hard to ensure that consumers are protected from common unfair insurance practices,” said Commissioner Miller. “Since it is the insurers’ responsibility to keep their provider directories up to date, my department will use its authority under the Unfair Insurance Practices Act to see that consumers who do their homework to make sure that the doctors and hospitals they are using are in their insurance network will not suffer financial harm just because those directories are out of date.”
Pennsylvania law prohibits unfair or deceptive acts or practices by insurers, including publishing or circulating an advertisement, announcement, or statement which is untrue, deceptive, or misleading. Commissioner Miller said that if a person receives health care services from a provider listed in the insurer’s provider directory as in-network, and the insurer then attempts to settle that claim as if the provider were out-of-network, her department will consider this to be an unfair claim settlement practice.
“The provider directory must be a source on which consumers can rely for critical health care information,” Commissioner Miller continued. “We have received complaints from people who have undergone major medical procedures, thinking the doctors and hospitals they used were in-network, only to receive surprise bills of hundreds or even thousands of dollars.”
Commissioner Miller reminded insurers that since open enrollment begins for many health plans on November 1, now is an excellent time to ensure their provider directories are up to date. The Insurance Department is examining the overall issue of surprise balance billing at a public hearing on October 1 in Harrisburg.