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Blair Horner: A Budget Issue Worth Fighting For

There is a lot in New York State’s budget that is important. Children need schooling, the poor and the sick need to be taken care of, the roads and bridges need repair, the public needs to be protected, and the courts need to administer justice.

But there are some things in the budget which are worth fighting for and not accepting “no” for an answer.

One of those issues deals with health insurance.

Two years ago the Cuomo Administration issued a report examining the issue of “surprise medical bills.”  A surprise medical bill is when a consumer who has done everything reasonably possible to use in-network hospitals and doctors, but nonetheless receives a bill from a specialist or other provider whom the consumer did not or could not know was out-of-network.  The report called for action to protect consumers from this practice.

And action must be taken.  Complaints of undisclosed and excessive charges occur even in emergency care settings, when no patient is thinking about in-network coverage.  Unexpected and, sometimes, excessive medical bills from out-of-network providers contribute to the growing problem of consumer medical debt, which continues to be a significant cause of personal bankruptcy.

Unfortunately, since release of the governor’s report two years ago this week, nothing has happened to protect patients from this practice.  As a result, they are at risk of unanticipated medical costs that can mean thousands, if not tens of thousands, of dollars.  Nationally, one in three Americans with health insurance reports having a hard time paying medical bills, one of the root causes is out-of-network charges.

Too often, consumers end up receiving out-of-network services without their knowledge.  In an emergency situation, a consumer may end up in an out-of-network hospital or treated by an out-of-network provider, with no time to choose otherwise.

Another consumer may have a non-emergency procedure in an in-network hospital or clinic, only to find that an out-of-network provider such as an anesthesiologist played some part in their care. These individuals are then faced with often enormous “surprise” bills. For example, one consumer complained of receiving emergency surgery at an in-network hospital, only to find out later that an out-of-network surgeon had performed the procedure; he was billed $58,000.

Another consumer got a bill for neck surgery   The patient thought she was in-network based on the surgeon’s web site and conversations with his staff.  But he wasn't, and after the surgery the doctor sends her a bill for $101,000.

Obviously, these financial hits are far too big for more consumers to handle.  So, the remedy should be clear: 

1.      Hold consumers harmless for surprise bills from emergency room or out-of-network charges that were outside of their control; and

2.      Require that consumers get in advance of any procedure whether all of their providers are in-network.

For two years, New Yorkers have been exposed to this possible financial catastrophe.  But hopefully not for much longer.

The governor put in his budget plan a proposal to protect consumers.  The governor’s budget proposes to protect patients from “surprise medical bills” by banning their use in emergency settings and by increasing disclosures that must be made to consumers by insurers.

Now it’s up to lawmakers to act.  As they put the final budget together they must ensure that consumers are not on the hook for surprise medical bills and that, in non-emergency, elective procedures, patients are adequately informed of the potential financial risks of going out-of-network.

The state budget cannot be considered complete until this issue is addressed.

Blair Horner is the Legislative Director of the New York Public Interest Research Group.

The views expressed by commentators are solely those of the authors. They do not necessarily reflect the views of this station or its management.

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