The Pennsylvania Medical Society has been a longtime champion of legislation that limits how long insurers have to retroactively deny claims.
The Medical Society believes that insurers should only have as long to deny claims as providers have to file them—ideally, about six months. Currently, Pennsylvania insurers have several years to review claims.
There already are some limits in place in Pennsylvania through the settlements of class action lawsuits against the state’s Blues insurers.
The insurers agreed to change certain business practices for four years, including having only 18 months to review claims. However, a legislative solution is still needed since these limits expire and don’t apply to all insurers.
A number of retroactive denial bills have been introduced in the General Assembly during the last several years, but they haven’t made it out of committee.
The Medical Society plans to work with state lawmakers this legislative session on introducing another bill to limit retroactive denials.