Out-Of-Network Protection In Emergencies

New protections against big surprise medical bills are starting in New York.

Enacted last year, they require insurance payments for out-of-network medical treatment in emergencies, when similar services or specialists are unavailable within the insurer’s network or when care is provided without the patient’s knowledge.

“The surprise bill is only in a situation where they couldn’t choose in advance,” said Dr. Andrew Kleinman, a surgeon and president of the Medical Society of the State of New York. “If they’re coming to see me in my office, that’s not a surprise.”

The immediate requirement for doctors and hospitals is to update online or give written notice to patients about the insurance networks they belong to and tell patients about treatment referrals to other doctors, lab testing or other services. Their trade associations have been providing briefings and guidance.

THOUSANDS OF CONSUMER COMPLAINTS

The Department of Financial Services, which regulates insurers, has received more than 10,000 consumer complaints about billing for out-of-network health care, Superintendent Ben Lawsky said. His agency was involved in drafting the law, which the Cuomo administration pushed.

“This is a huge national problem,” Lawsky said. One other state, Illinois, has taken a similar approach to drop consumers out of billing disputes between insurers and care providers, and officials in many other states have taken an interest in New York’s approach, he said.

Chuck Bell, program director for Consumers Union, said it should remove consumers from the disputes that could drag on for months and now can go to independent dispute resolution.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary