Retroactive Review - HB 1178, SB 554 and HB 2241

Sponsored by State Representative Stephen Barrar (R, Delaware) and State Senator David Argall (R, Berks) HB 1178 and SB 554 would prohibit healthcare insurers from retroactively reviewing paid claims beyond a 12 month period from the date of payment. Each bill was referred to their respective insurance committees. In addition, State Representative Karen Boback (R, Luzerne) sponsored HB 2241 which contains the compromise language negotiated among the healthcare provider community and the insurer industry. Representative Boback’s HB 2241 is slated to be presented to Governor Tom Wolf for enactment by October’s end.

Currently, insurers have no statutory restrictions on look back periods and may retroactively deny reimbursement to health care providers at any time. And, healthcare insurers may unilaterally reduce future payments to recover the denied amount. The compromise bill prohibits retroactive denials of paid claims beyond 24 months.