Starting next year, patients in New York will be protected from the surprise out-of-network medical bills that have pushed some toward personal bankruptcy.
The measure signed into law this week is scheduled to take effect April 1, 2015. It was proposed by the Cuomo administration, approved by the Legislature with some revisions and backed by consumer groups. It will require doctors and hospitals to more clearly notify patients about who is in their insurance networks and who is not.
"For older patients, the unexpected bills can break their delicate kitchen table economies," said Beth Finkel, AARP New York state director. "This legislation is much needed in New York."
Meanwhile, state insurance officials will write regulations on coverage and disclosures to patients and establish an arbitration process intended to settle related billing disputes between doctors and insurers, leaving patients out of them.
Financial Services Superintendent Ben Lawsky said his department now receives thousands of complaints annually from insured patients stuck with huge bills.
In emergencies, patients will be able to get treated by providers outside their insurer's network and pay only their usual fees. They also will be protected from having to pay big out-of-network bills from doctors they weren't told about.
"Because the bill is going to create a new set of disclosures for people to know if there's going to be an out-of-network provider involved in their treatment and how much that will cost them, our hope is there'll be far fewer of these kinds of disputes to begin with," Lawsky said.
With a dispute resolution similar to Major League Baseball, where the arbitrator will consider a series of factors and choose between one side's proposal or the other, it is an incentive to both doctors and insurers to be reasonable and not propose outlandish numbers, he said.
The law is intended to protect patients who try to stay in networks and won't protect those who, for example, simply choose to visit an expensive doctor outside their network, Lawsky said.
It covers specialists when appropriate doctors aren't available within a network, which he called "a nice incentive" for insurance companies to ensure their networks are adequate. Another provision requires insurers to let patients file claims online and not require traditional mail.
"My hope is it won't be a huge burden on the insurance companies and you won't see premiums rising all that much to cover it," Lawsky said. "We'll see how it all plays out."
Dr. Sam Unterricht, president of the Medical Society of the State of New York, said the final negotiated law is comprehensive, balanced and addresses the myriad issues "relating to out-of-network care and inadequate insurer networks." He said the society will work with the Department of Financial Services to ensure physicians' offices statewide are aware of the law, new disclosure requirements and dispute resolution.
Jeffrey Gold, head of managed care for the Healthcare Association of New York State, said that on balance, it's a big step forward.
"It finds a way to insulate consumers from balance bill liability. It takes hospitals, we hope, out of middle of the crossfire. And it finds, we hope, a reasonable and appropriate method of compensation for highly skilled physicians that's fair," Gold said. "It remains to be seen whether the disclosure methodologies are going to work as well as we hope and if the dispute resolution process really does in fact resolve payment in a fair way."