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Medical Billing Disputes Could Be Settled through Arbitration

Saturday, February, 6, 2016

Pennsylvania Insurance Commissioner Teresa D. Miller suggested patients should no longer be involved in medical balanced billing disputes after she spent months studying the issue. She made her proposal recently during the public comment period that lasts until February 29th and pointed out insurance companies and health care providers should use arbitration if they are unable to reach an agreement on billing issues. The proposal would require state legislation. The original investigation into the dispute began when the Reading Eagle wrote that a local insurance agent complained a patient was being billed twice for mammogram screenings.


Speaking after she made her public comments regarding billing disputes, Miller stated there is really not a clean way to resolve billing issues without legislation. She stated a balance bill occurs when a doctor group, which could include ER doctors, radiologists, etc., charge more than what the insurance company agrees to pay. She points out that patients choose to see primary care doctors, but less often choose to see specialists. It is a necessary doctor visit and it is not right for patients to be forced to foot the bill.


According to a Penn State Health St. Joseph spokesman, “… balanced billing is an issue that independent physicians/physicians groups and insurers need to address.”


Balanced billing disputes are not only an issue in Pennsylvania. States including Colorado, New York, and Texas have all corrected the problem, and other states are moving in that direction. A unique solution might be needed on a state by state basis, but a solution is possible.