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19 Patient & Physician Groups Applaud Pennsylvania Legislation to Prohibit Unfair Health Plan Changes

House Bill 853 Amends Pennsylvania Insurance Law to Restrict Midyear Coverage Reductions for Health Care Treatments & Services

April 1, 2019 – Pennsylvanians for Fair Health Coverage, a coalition of nineteen patient and provider groups, today applauded legislation that protects consumers with commercial health insurance from unfair midyear health plan coverage changes, known as “non-medical switching.” Pennsylvania House Bill 853 would amend Pennsylvania’s Unfair Insurance Practices Act to prohibit commercial health insurers from making coverage changes during the policy year that deny or increase the cost of a treatment, service or prescription that a patient is already receiving. Pennsylvania Representative Donna Oberlander (R – Armstrong, Clarion and Forest counties) is the prime sponsor of the bill, which has over 20 cosponsors, including both Chairs of the House Insurance Committee. The bill has been referred to the House Consumer Affairs Committee.

“Right now, insurers in Pennsylvania are free to raise out-of-pocket costs or deny medical care at any time, even when individuals and families are locked into their plans for the duration of the year,” said Rep. Oberlander. “It’s important that every insured Pennsylvanian, especially those battling serious health issues, receive the health benefits that were advertised to them when they signed up for a plan.”

Oberlander continued, “Insurers play a critical role in making health care accessible, so the goal of this legislation is to protect consumers in a way that doesn’t inhibit business. House Bill 853 will only prohibit insurers from reducing coverage mid-policy year for patients who already depend on products, services, procedures, treatments and prescription drugs. The legislation will not impact an insurer’s decision to change coverage options for patients not already being treated, nor will it limit their ability to add new therapies and services or to remove unsafe treatments.”

Right now, commercial insurers in Pennsylvania are free to raise out-of-pocket costs or deny medical care at any time during the health plan year, even when individuals and families are locked into their health policy for the year. House Bill 853 does not impact a health plan’s ability to alter covered benefits for commercially insured Pennsylvanians who are not already receiving a specific service, treatment or prescription drug. The legislation also does not limit health plans’ ability to alter coverage if a product or service is deemed unsafe by the U.S. Food and Drug Administration (FDA) or when production of a prescription drug has been discontinued.

“When a health insurance company makes coverage changes during the policy year, the health and financial consequences can be overwhelming,” said Suzanna Masartis, executive director of the Community Liver Alliance, which leads Pennsylvanians for Fair Health Coverage. “House Bill 853 would ensure that Pennsylvanians with commercial coverage have reliable access to the care and services they need.”

California, Illinois, Louisiana, Maine, Nevada, and Texas have already implemented similar policies to protect patients from coverage reductions during the plan year. Pennsylvania House Bill 853 mirrors 2018 legislation that was also referred to the House Consumer Affairs Committee.

“As a physician, I know firsthand how much work goes into finding the right treatment for patients who are managing a digestive disease or any other complex condition,” said Dr. Ralph McKibbin, a practicing gastroenterologist and Immediate Past President of the Pennsylvania Society of Gastroenterology (PSG). “When insurance companies make decisions that interfere with that relationship and process, the effects for those who rely on certain treatments can be physically, emotionally, and financially devastating. House Bill 853 would protect the treatment decisions made by physicians and their patients.” 

About Pennsylvanians for Fair Health Coverage

Pennsylvanians for Fair Health Coverage is a coalition of patient and provider groups working to ensure that commercial health insurance benefits will be concrete over the course of each year. All we ask is that insurers honor contracts with patients.

Members include: American Autoimmune Related Diseases Association, Arthritis Foundation, Blair Gastroenterology Associates, Chronic Disease Coalition, Community Liver Alliance, Eastern Pennsylvania Chapter of the National Hemophilia Foundation, Global Healthy Living Foundation, Lupus and Allied Diseases Association, National Infusion Center Association, National Kidney Foundation, Pennsylvania Academy of Dermatology, Pennsylvania Association of Community Health Centers, Pennsylvania Medical Society, Pennsylvania Society of Gastroenterology, Pennsylvania Society of Physician Assistants, Pennsylvania State Nurses Association, Rehabilitation and Community Providers Association, U.S. Pain Foundation, Western Pennsylvania Chapter of the National Hemophilia Foundation.

For more information, visit faircoveragepa.org.

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