Tag Archives: Out-of-Network

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.


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.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Tips You Should Know to Avoid Hefty Medical Bills

Jeffrey Craig Hopper is a probate attorney and Little League coach in Austin, Texas, so he knows all about following the rules. Still, accidents happen. Last June on the Little League field, an errant baseball smashed into his face.

His wife, Jennifer, remembers rushing to the field.

“His eye was swollen shut enough that we weren’t sure if he could see,” she says.

Even in that moment of panic, Jennifer Hopper realized that there are rules when it comes to using health insurance that can hugely influence the size of the medical bill. Care providers who are “in network,” she knew, cost much less, so she made absolutely sure to drive Jeffrey to the emergency room of a hospital in Austin that is part of their insurance network.

That sounds straightforward, but, as the couple soon learned, it doesn’t always work out that way — some patients still get slapped with big bills, even when they try to play by the rules.

In the end, Jeffrey was OK — the ball broke some facial bones around his eye, but they healed and his vision was fine. Jennifer, however, was surprised by what happened next. After she’d already settled with the hospital, paying the copayments for the ER, the ER doctor sent the couple a separate bill for more than $700.

“It felt kind of random,” she says. “How do I know who’s going to charge me, and who’s not going to?”

Like many patients, Hopper assumed that if she went to a hospital that the insurance company had designated as being within her network, the doctors who work there would also, of course, be in the network.

But that’s not necessarily true. Emergency room doctors, radiologists and anesthesiologists often don’t work for the hospital. They work for themselves, often in large practice groups, and it’s up to them to sign their own deals with insurance companies.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Push for Consumer Protection from Out-of-Network Medical Bills

Benjamin M. Lawsky, Superintendent of Financial Services is urging New York State Legislatures to push a state budget protecting consumers for surprise out-of-network medical bills.

Joined by consumer advocates, Superintendent Lawsky implores Legislators to protect New Yorkers who have done everything right and then are hit with a surprise bill that can run into the tens of thousands.

“Surprise medical bills are an expensive and unfair burden for patients and their families,” said Chuck Bell, programs director for Consumers Union, publisher of Consumer Reports.  “Consumers around the state are fed up with the unnecessary risks and hassles of surprise bills for out-of-network care, and they are demanding change. Governor Cuomo’s proposed legislation provides a well-designed, comprehensive solution to a very difficult problem.  The governor’s plan systematically targets the root causes of surprise bills, and creates a comprehensive framework to dramatically reduce their incidence and severity.”

To read more, click here.

Jeffrey R. Ungvary


Jeffrey R. Ungvary