HARRISBURG, PA — A group of bipartisan lawmakers has introduced legislation aimed at increasing accountability among health insurers for denying claims deemed medically necessary. House Bill 966, sponsored by Representatives Arvind Venkat, Paul Friel, Bridget M. Kosierowski, and Tom Mehaffie, seeks to address growing concerns about unjust claim denials and their impact on patient care in Pennsylvania.
The proposed bill would require health insurance companies to publish public reports on the rate of denied claims overturned during the appeal process. Insurers with an appeal success rate exceeding 50% would face escalating financial penalties to deter systematic denials of coverage.
“A denial rate of over 50% suggests a disturbing pattern of systematically denying coverage for medically necessary care,” said Rep. Venkat, D-Allegheny. “It’s my duty to help patients across the state receive the coverage for which they have already paid.”
The bill highlights concerns about the complexity of the appeals process, which many patients abandon due to its burdensome nature. Rep. Friel, D-Chester, emphasized that the new legislation aims to address these inefficiencies while protecting policyholders. “Increasing financial penalties encourages insurers to uphold the rights of their policyholders,” he said.
The issue of claim denials has gained attention in part due to the Pennsylvania Insurance Department’s Independent External Review program, launched in 2023. The program found that over half of the appeals it reviewed involved wrongful terminations of care by insurers, further underscoring the need for reform.
Rep. Kosierowski, D-Lackawanna, described the legislation as an opportunity to rebuild public trust in the health insurance industry, which has faced criticism for putting profits over patient well-being. “This legislation encourages insurers to be more cautious in evaluating claims,” she stated.
Echoing this sentiment, Rep. Mehaffie, R-Dauphin, noted the human impact of coverage denials on his constituents. “It is important for insurance companies to see the person, not the paperwork,” he said.
The bipartisan measure has been referred to the House Insurance Committee and signals a concerted effort to curb systemic claim denials while ensuring patients across Pennsylvania receive the care they need.
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