New York State is ahead of the curve on addressing the financial consequences of out-of-network care, a more and more likely scenario with “narrow” networks.
The New York Times article noted: If you “… are stuck with a surprise bill, patients will be responsible only for whatever their co-pay would be if the doctor were in-network.”
“Every year, thousands of New Yorkers find themselves responsible for a surprise medical bill from a doctor, like an anesthesiologist, who becomes involved in their care but, unbeknown to the patient, is not covered by their insurance.”
“Usually the doctors involved are not the primary physician whom the patient has come to know but a radiologist, pathologist or anesthesiologist involved in a procedure, like surgery or colonoscopy. Sometimes, patients make it to the operating table before they learn that the out-of-network doctor is involved in the operation.”
“Now a provision in the state budget agreement … is intended to protect consumers by requiring that they be given a reasonable amount of notice when an out-of-network doctor will be treating them.”
“If they are stuck with a surprise bill, patients will be responsible only for whatever their co-pay would be if the doctor were in-network. The out-of-network doctor and the insurance company will have to hash out the bill using what is known as baseball arbitration, with each proposing a price and an arbitrator choosing one of them. The law will go into effect in one year.”
Click here to read the full New York Times article “New York Curbs Medical Bills Containing Surprises” by Anemona Hartocollis.
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Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.