The Cuomo administration has proposed protecting medical patients from surprise out-of-network medical bills by placing responsibility for those disputed amounts with insurers and providers.
The Department of Financial Services says it regularly receives complaints from consumers.
Department Superintendent Ben Lawsky says it’s the top complaint related to health insurance and can leave patients many thousands of dollars in bills that can drive them into bankruptcy.
The administration is pushing new legislation that would hold patients harmless from those bills in all emergency situations and non-emergencies where doctors and hospitals don’t make required disclosures.
Elisabeth Benjamin of the Community Service Society says incidents with surprise medical bills happen all the time, for example with an anesthesiologist or other specialist who’s not part of a patient’s insurance network.
(AP)
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7 Responses
This means that providers will insist that the patient pay for the service “up front” and that the patient deal with getting paid by the insurance (which is how it worked traditionally with insurance). This will be very inconvenient for some patients who might have trouble coming up with money up front.
The anesthesiologist problem can be solved either by hospital having to include any services they are offering in the hospital bill, or by the attending physician being in charge of recuriting an anesthesiologist (as a subcontractor). I suspect that if a patient refuses to pay the patient will usually win in court since the patient never agreed to the anesthesiologist’s fee, and a court would not enforce the bill unless it can be shown that the patient had agreed (lack of meeting of the minds on a critical term, in this case price).
akuperma, you’re partially mistaken since insurance carriers contracts with medical providers prohibit the doctors from charging the insured upfront. They are required to first bill the carrier.
A number of years ago at the intake desk of the maternity ward for Maimonidies Medical Center in Brooklyn I experienced a (not so) funny exchange between a husband, wife and the intake desk. The woman behind the desk passed along a bunch of papers to be signed. The husband glanced at the papers and then wrote something on the form which was immediately challenged by the clerk. He wrote on the form that hospital agrees that ALL medical services would be provided by personnel who were in network to his insurance plan, since he was in an “in network hospital” and it is not reasonable to expect that the patient or a representative be expected to ask every time someone stops by to perform a service if they are “in network”. The clerk vehemently argued that he could not alter the form in any way. He insisted he would not sign the forms without the added clause. After 5 minutes or so of the back and forth, the poor woman in labor told both of them they could continue their argument but she was going back to see a nurse! The “impasse” was “resolved” a few minutes later when the clerk had to leave her desk to take care of something. The husband wrote the clause on a different page of the intake forms and when the clerk came back he said, “OK, here, I signed the form”, and she accepted the paperwork from him without looking at any other pages. She gave him his copy and everyone was happy.
Yes, 6 weeks later he started getting bills from personnel who were not paid (or not as much as they billed) since they were out of network….and he sent them back a copy of the paperwork which included the clause he inserted and told them to go bill the hospital! Needless to say, neither the provider or hospital were happy, but, they had no choice but to leave him alone (after 3 more months of trying to get him to pay and him filing a complaint with the NYS Insurance Dept. and better business bureau).
I was forewarned by a co-worker of mine who told me that this hospital in particular is notorious for the “out of network” problem and their nickel and diming their patients and to make sure I inserted that clause, somehow, someway into the intake forms.
When a person is admitted into the hospital and the hospital says he is covered, reason would indicate that ALL services provide by ALL personnel and doctors would be covered. The patient is then invariably billed separately by the various attending physicians. This is ridiculous!
This practice is deceptive and immoral and all too common!
This will help consumers, but will likely force insurance companies with incompetent claims departments out of the state, and hospitals with incompetent billing departments out of business completely.
One can argue that both are good things!
Doc: akuperma is right. The article is talking about out of network providers, who dont have a contract with the ins co.
I dont know about physicians, but in NY state, a hospital is not allowed to turn someone away due to concerns over payment. While they might make sure to get every morsel of insurance info out of you, they cant deny you service.