Pennsylvania Regulator Warns Health Insurers About Provider COVID-19 Bills

 By Allison Bell | July 02, 2020 at 01:07 AM

Altman says insurers should consider referring the worst cases to

Pennsylvania’s top insurance regulator is warning health insurers in the state that some doctors and dentists have been sending patients inappropriately high COVID-19-related bills.

Jessica Altman, the Pennsylvania insurance commissioner, says in a new notice that the Pennsylvania Insurance Department has been seeing two main types of potentially inappropriate bills.

One is dentists imposing extra charges for masks and other personal protective equipment and supplies.

The second is laboratories or other testing companies charging very high prices for tests for the virus that causes COVID-19.

Resources

·        A copy of the new Pennsylvania notice is available here.

·        An article about Molina health plan enrollees with COVID-19 is available here.

Some dental plans may have provider agreements and coverage contracts that let dentists pass personal protective equipment costs on to the patients, but other plans may not, Altman writes in the new notice, Notice 2020-19.

Similarly, Pennsylvania does let doctors and testing companies set COVID-19 prices, according to the notice.

But, even if doctors have warned patients about the testing prices, by posting the prices in their offices, “some laboratories or other testing services are charging amounts that are well in excess of their costs,” Altman writes. “Even if the charges are publicly posted, the amount may be considered improper price gouging.”

If a health insurer or dental insurer finds in-network providers engaging in either of those  billing practices, the insurer should see if it can use the terms of the provider agreement to get the providers to stop doing that, Altman says.

“Where the provider engaged in either of these billing practices is not in a health insurer’s network, or where any action taken does not result in a resolution that avoids imposing costs on insureds, the health insurer may wish to consider making a referral to the Office of Attorney General at pricegouging@attorneygeneral.gov,” Altman says.

Insurers should also consider warning consumers about the problem billing practices, and it want to provide tools consumers can use to file complaints, either with the insurer or with the state’s attorney’s general office, Altman says.

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