Claudia’s Story

Read Claudia Knafo’s Story about a surprise Out-Of-Network medical bill

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FOR IMMEDIATE RELEASE

February 27, 2014

GROUPS CALL ON LEGISLATURE TO PASS LEGISLATION PROTECTING CONSUMERS FROM SURPRISE MEDICAL BILLS

Albany, NY – February 27, 2014 – New Yorkers for Accessible Health Coverage (NYFAHC), Consumers Union, American Cancer Society Action Network and AARP threw their support behind legislation that will protect consumers from surprise medical bills.

The groups are urging the State legislature to pass this legislation to protect New Yorkers who through no fault of their own find themselves deep in debt.

One New Yorker, Claudia Knafo, a concert pianist, received a surprise medical bill for $101,000 for neck surgery, for which her health plan offered to pay only $3,500.  She could not pay the $97,000 balance and was forced to consider declaring bankruptcy.  “I could no longer take this stress,” says Claudia, “Ironically my post-operative instructions had been to cancel all concerts, and to keep my neck in a neutral position for 2 months.  I never had a chance, as I had to spend hours a day at the computer writing letters of appeal.”  The dispute dragged on for seven months before it was resolved through the intervention of the state Dept of Financial Services.

“Surprise medical bills are unreasonable and unacceptable hardships for patients, especially for people who paid extra for out-of-network coverage,” said Chuck Bell, programs director from Consumers Union, publisher of Consumer Reports.   “While some people may think of surprise bills as an exceptional or occasional event, each year over 3,000 patients contact New York state regulators or their insurance company with complaints about them.  These are just the tip of the iceberg, because many patients can’t understand medical bills or insurance terms, and don’t know who to complain to.”

“It is imperative that legislators approve the strong bill proposed by Gov. Andrew Cuomo now, which offers a comprehensive solution to this problem,” Bell said.  “Gov. Cuomo’s plan is the plan that best meets the needs for the consumers.  We need this bill to be adopted now, so we can protect New York patients and families against uncontrolled and unexpected medical expenses.”

The legislation proposed as part of the Governor’s budget would hold consumers harmless for surprise bills for out-of-network charges outside of their control; set a fair process for providers and insurers to negotiate coverage disputes; improve transparency to prevent surprises.

“High medical bills are destroying many New Yorkers’ kitchen table economies, and surprise out-of-network insurance charges can be the straw that breaks the camel’s back,” said David McNally, Manager of Advocacy for AARP in New York. “Any effort to protect consumers from these charges and provide transparency to avoid and resolve them is a positive step. AARP commends Governor Cuomo and Superintendent Lawsky for committing to tackle this issue, and we urge our state legislators to adopt the Governor’s proposal as part of the final state budget.”

The groups say that the governor’s bill has been carefully developed to create stronger standards for network adequacy, better upfront information about out-of-network providers and reimbursement levels, expansion of consumer appeal rights for treatment decisions, and independent arbitration when the health plan and provider can’t agree on how much is to be paid.

“Cancer patients often experience pain from their treatments and are not in a position to carefully review the network status of every health care professional providing treatment,”  said Michael Burgess, State Advocacy Director of the American Cancer Society Cancer Action Network.

“People shouldn’t end up near bankruptcy because they did not know that some of their service providers were out of network.  It’s hard enough to fight for your health without worrying about losing your home,” said Heidi Siegfried, Project Director of New Yorkers for Accessible Health Coverage.  This is a common-sense solution to a problem that creates undue hardship for people who can least afford it.  We need our State legislators to support this legislation.”

-END-

CONTACT:

Heidi Siegfried of New Yorkers for Accessible Health Coverage, 646-442-4147  hsiegfried [at] cidny.org

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