Over 3,000 New Yorkers complain to state regulators and insurance companies every year about surprise medical bills that they did not expect to receive. Many of these complaints are related to Out Of Network health insurance coverage. While the Out of Network health insurance system has been partly reformed, some health plans have cut reimbursements by using other benchmarks for determining payment, such as a multiple of the Medicare rate. In other cases, consumers have difficulty determining whether their doctor or provider is in-network or out-of-network.
The problem of surprise medical bills are explained in detail in a state report called “An Unwelcome Surprise: How New Yorkers are Getting Stuck with Unexpected Bills from Out-of-Network Providers,” published by the New York Department of Financial Services on March 7, 2012. The report explains that consumer get surprise bills because of many different reasons, including inadequate networks, outdated provider directories, lack of appropriate disclosures to consumers, changes in reimbursement practices, and problems in receiving unexpected or emergency care. The consequences of surprise bills include financial and psychological stress, medical debt, ruined credit, and even bankruptcy.
In his state of the state address for 2014, Gov. Andrew Cuomo proposed comprehensive legislation to protect patients against surprise out-of-network charges. The full text of Gov. Cuomo’s proposed legislation is available here and a summary is available here. Over 50 consumer, health care and community organizations have already endorsed Gov. Cuomo’s legislation. The bill (S 6357B and A.8557B Section U) contain strong provisions to expand consumer information, improve appeal rights for treatment decisions, strengthen standards for network adequacy, and create independent arbitration to resolve billing disputes where the health plan and provider can’t agree how much should be paid, taking the consumer out of the middle of the dispute.
We’ve created this web site to help connect patients, advocates and families who are concerned about surprise medical bills. By working together, we hope to rally public opinion to solve this problem now, so New Yorkers can focus on getting the health care they need, without having to worry about stumbling into a personal financial disaster.
To read stories from New Yorkers who have received surprise medical bills, click here.