MSSNY PRESIDENT DR. ANDREW KLEINMAN COMMENTS ON LACK OF OUT OF NETWORK COVERAGE IN 2015 NYS EXCHANGE PLANS
WESTBURY, NY (04/29/2014)(readMedia)-- "All New Yorkers have a right to see the physician best able to treat their particular condition, which is why out of network coverage is critical for the health of all New Yorkers. The decision not to require health insurers to offer out of network coverage on New York's nationally-acclaimed insurance Exchange would not be a problem if insurers would offer this coverage sought by many New Yorkers. Instead, to date, they have not stepped up. Patients want the right to purchase coverage that enables them to see the physician of their choice. It should at least be an option for coverage on the Exchange among many offerings. We are disappointed it is not being required, at least for the several companies offering coverage in New York's Health Insurance Exchange like Empire and United that have traditionally made out of network health insurance coverage available for consumers as well as employers. Consumers are not being offered the same choices as those that are being offered in the group market.
No one outside of Western New York has the option to purchase a policy on the individual Exchange market that allows them to see the physician of their choice. This is an affront to patients and physicians across the State of New York. It also exacerbates the problem we have seen in New York's Exchange regarding the often limited networks that reduce patient choice to see the physician best able to treat their particular condition. The provisions enacted in the recent State Budget to enable New Yorkers to go out of network if the existing network does not contain physicians with suitable expertise to treat the patient's condition take steps towards addressing this problem. However, more needs to be done. In light of the decision not to mandate out of network coverage, New York State Exchange officials now must work to assure that health insurers voluntarily make such out of network coverage available. And networks should be sufficient to meet patient needs."
Founded in 1807, the Medical Society of the State of New York is the state's principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.