Pennsylvania Sen. David Argall (R-Schuykill-Berks) recently introduced a bill which would limit insurers to a year to challenge a bill to a provider.
The legislation would require insurance carriers to review treatment plans, claim forms and bills within a year. It would also require a written statement from the insurer explaining the basis for any retroactive denial so the physician understands what the denial is.
According to the Pennsylvania Medical Society, inefficient claim processing and payment can take up 10-14 percent of work time for a physician.
“We want these medical professionals to be spending their time helping people get better, not spending their time looking for records from four or five years ago,” Argall said.
This bill concerning retroactive denial of health insurance claims was proposed after Argall kept hearing about this problem from constituents.
“From time to time, they’d get a call from their insurance company and they are being told that two years ago, three years ago, four years ago, they submitted a claim, they were reimbursed but now they have to give the money back,” Argall said.
This is the third consecutive legislative session in which this bill has been introduced. In 2007, a similar bill passed in the House, but not the Senate.
The Pennsylvania Medical Society supports the bill.
