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

House Bill 2113 Amends PA Insurance Law to Restrict Coverage Reductions for Health Care Services & Treatments During the Policy Year

February 27, 2018 – Pennsylvanians for Fair Health Coverage, a coalition of more than ten patient and provider groups, today applauded legislation that protects consumers with commercial health insurance from unfair health plan changes. Pennsylvania House Bill 2113 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. Rep. Donna Oberlander (R – Armstrong, Clarion and Forest counties) is the prime sponsor of the bill, which has 16 cosponsors. The bill has been referred to the House Consumer Affairs Committee.

“When a health insurer fails to honor the benefits it sold, Pennsylvanians lose,” said Rep. Oberlander, prime sponsor of House Bill 2113. “My legislation closes an important loophole by preventing health plans from raising costs or removing coverage for a treatment or service a consumer is already receiving.”

Oberlander added, “I believe Pennsylvania’s constituents should get the coverage they paid for, especially considering they can’t change plans during the year. 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.”

Right now, commercial insurers in Pennsylvania can raise out-of-pocket costs or deny medical care at any time, even when individuals and families are locked into their health policy for the year. House Bill 2113 does not impact an insurer’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 FDA or when production of a prescription drug has been discontinued. It  is modeled after principle number five contained in the American Medical Association’s Prior Authorization and Utilization Management Reform Principles.

“When a health insurer 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 2113 would ensure that Pennsylvanians with commercial coverage have reliable access to the care and services they need.”

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: Blair Gastroenterology Associates, Community Liver Alliance, Global Healthy Living Foundation, National Kidney Foundation, Pennsylvania Academy of Dermatology, Pennsylvania Association of Community Health Centers, Pennsylvania Medical Society, Pennsylvania Society of Physician Assistants, Pennsylvania State Nurses Association, Rehabilitation and Community Providers Association, U.S. Pain Foundation, Western PA Chapter of the National Hemophilia Foundation. For more information, visit http://faircoveragepa.org.



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