MSSNY President Commends NYS Senate for Passing out of Network Reform Legislation

WESTBURY, NY (06/27/2013)(readMedia)-- "The New York State Senate is to be commended for overwhelmingly passing legislation (S.2551, Hannon) prior to the end of the Legislative Session that would comprehensively address the issue of 'surprise medical bills' received by our patients. We are disappointed the Assembly did not act on this issue, but look forward to continuing discussions throughout the summer and fall.

From our perspective, a major contributing factor to this problem is that health insurers have drastically reduced their levels of coverage for policies that enable patients to see the physician of their choice. Because the insurance benefits that the consumer or employer paid for are often far less than the likely costs of care (sometimes as little as 10-20%), the increased financial responsibility for patients seeking out of network care is both substantial and unexpected.

Essentially, these policies cover almost nothing.

Senator Hannon's legislation would address this problem. It would require health insurance companies to clearly disclose to patients the true scope of their out-of-network coverage, set as a percentage of the likely costs of care as reported in the independent non-profit FAIR Health database This would enable patients to easily understand and anticipate their out-of-pocket costs for a particular treatment if they have out-of-network coverage and choose to be treated by an out-of-network physician. Moreover, to better assure that employers and patients get what they pay for, the legislation would require a health insurance company offering a policy for out-of-network coverage to assure that there is significant coverage of such costs.

This legislation would also impose new obligations on physicians to greatly reduce "surprise" medical bills. Out-of-network health care providers would, for the first time, be statutorily obligated to disclose anticipated charges for care, as well as be required to disclose important information concerning additional health care providers who may be involved in the patient's care. The legislation would also establish a fair dispute-resolution mechanism overseen by the Department of Financial Services to enable health insurance companies to challenge bills for emergency room care provided by out-of-network providers when excessive billing for such care is alleged.

Perhaps most importantly, the legislation would address problems faced by patients concerned with the adequacy of their health insurance coverage. It would assure that all health insurance products issued in New York State offer comprehensive provider networks sufficient to meet the needs of the patients enrolled in that product. It would also afford patients enrolled in all health insurance products the right, currently available only to those enrolled in HMOs, to receive treatment from a specialist appropriately qualified to treat a patient's particular condition at no additional cost to the patient, if the network of such insurance product fails to include such appropriately qualified specialist.

The bill presents a fair compromise on the myriad of issues that cause surprise medical bills. Patients who pay for the right to see the physician of their choice should truly be able to avail themselves of this right. We urge that this legislation be taken up by the Assembly and passed into law."