Consumer Protections
Medical Billing Protections in Pennsylvania
In addition to federal protections like the No Surprises Act, Pennsylvania has its own consumer protection laws that may apply to your medical billing dispute. Here is an overview of the protections available to you.
Key Facts: Pennsylvania Medical Billing Protections
Dispute Window
180 days from Explanation of Benefits (EOB)
Applicable Statute
Consumer Protections
Consumers may file complaints with the Pennsylvania Insurance Department for unfair billing practices
Surprise Billing Protection
Federal No Surprises Act applies
Balance Billing Restrictions
Federal protections only
Key Consumer Protections in Pennsylvania
- The federal No Surprises Act protects patients from surprise out-of-network bills for emergency services.
- Pennsylvania does not have a comprehensive state-level surprise billing law; federal protections apply.
- Patients have the right to request an itemized bill from any healthcare provider.
- Pennsylvania law requires insurers to process clean claims within 45 days.
- Consumers can file complaints with the Pennsylvania Insurance Department.
Read the full statute: 40 Pa. Stat. § 991.2166
Disclaimer: This information is for general informational purposes only and does not constitute legal or professional advice. Laws and regulations may change. Consult a licensed attorney or certified medical billing advocate for advice specific to your situation.