Venkat, Friel, Kosierowski, and Mehaffie introduce bipartisan legislation to hold health insurers accountable for denying reimbursement claims
Rep. Paul Friel March 24, 2025 | 1:59 PM
HARRISBURG, March 24 – State Reps. Arvind Venkat, Paul Friel, Bridget M. Kosierowski and Tom Mehaffie have introduced a bipartisan bill that would hold health insurance companies accountable if they systematically fail to reimburse Pennsylvanians receiving medically necessary care.
The legislation (H.B. 966) would require health insurers to issue a public report on the frequency of rejected claims that are overturned on appeal and pay escalating fines if more than 50% of their claim denials are overturned on appeal.
“A denial rate of over 50% suggests a disturbing pattern of systematically denying coverage for medically necessary care. Not only that, these entities are assuming Commonwealth residents will be deterred by the mountain of red tape necessary to file an appeal,” Venkat, D-Allegheny, said. “Collaborating with bipartisan colleagues on this legislation means more than holding insurers accountable. As an emergency physician, it’s my duty to help patients across the state receive coverage for which they have already paid to maintain and improve their health and well-being.”
“An increasing number of people are aware that they can challenge denied health care claims through their insurer and, if necessary, the Insurance Department. However, the appeals process can be lengthy and complex, leading many to forgo it due to the administrative burden involved,” Friel, D-Chester, added. “The potential for increasing financial penalties when a pattern of overturned claim denials emerges encourages insurers to be more diligent in evaluating claims and to uphold the rights of their policyholders.”
“The risk of escalating monetary penalties for an established pattern of claims denials being overturned would encourage insurance companies to be more cautious in their claims evaluation process,” Kosierowski, D-Lackawanna, said. “It would be a step in helping to restore trust in the health insurance industry, which has been eroded by practices perceived as prioritizing profits over patients.”
“I am frequently hearing from constituents concerned about not having access to the treatments and procedures their doctors say are necessary,” Mehaffie, R-Dauphin, added. “It is important for insurance companies to see the person, not the paperwork.”
The Pennsylvania Insurance Department launched the Independent External Review program at the beginning of last year. This initiative, focused on reversing health insurance claim denials, determined that more than half of the 500-plus appeals it processed were due to wrongful termination on the part of insurers.
The legislation has been referred to the PA House Insurance Committee.