New York Fighting Over Medical Billing

Surprise medical bills have long been a battleground issue for Andrew Cuomo, both before and after he became governor. This year’s budget includes consumer protections against surprise bills from out-of-network providers. The new law takes effect in April.

But four months before implementation, the law still is a work in progress. Two of the health care industry’s most influential playersphysicians and insurersdisagree on final rules, which have yet to be issued by state insurance regulators. The state Department of Financial Services declined to comment for this story.

Providers and insurers are still exerting influence over how the new law will be implemented, with concerns over who has responsibility to disclose what providers charge, and how to benchmark reasonable fees. Fighting among providers and insurers has derailed similar legislation in Maryland and Colorado, said Jack Hoadley, a research professor at Georgetown University’s Health Policy Institute. Policy experts hope New York won’t be next.

“New York has a chance to try something and make it work, and that really hasn’t happened before,” said Mr. Hoadley.

The challenge with out-of-network fee legislation, he added, “is to make sure that you’re not left with either the provider or the insurance company completely holding the bag.”

Pressure for a law in New York intensified in 2012 after the state Department of Financial Services issued a report that examined the issues underlying some 2,000 annual complaints about medical billing.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary