Response to NY Times 9/21/14 Story on Out-of-Network Issues:
We fail to understand why the author waited until the last paragraphs of her lengthy article to note that New York just enacted comprehensive legislation to address the problem of “surprise” medical bills. The new law requires disclosure by out of network physicians of the expected costs of needed care, requires disclosure of additional physicians involved in the patient’s care, and creates a new arbitration process between insurers and out of network physicians that removes the patient from the dispute. It should go a long way to remedy the situations faced by the patients presented in the article.
We also strongly encourage patients to ask their physicians anticipated charges and check the fee database www.fairhealthconsumer.org
for estimates of the cost of medical procedures in their region.The new law also importantly places new obligations on insurers to prevent surprise bills, whose own culpability in this problem was shockingly neglected in this article. Insurers have caused this problem by slashing what they will pay their in-network physicians to levels that won’t even cover practice overhead, creating minimal networks, and limiting coverage for out of network care. Governor Cuomo and the Legislature recognized these problems and required insurers to: offer adequate networks; offer comprehensive out of network coverage options; and disclose to enrollees how their often-miniscule out of network coverage actually translates to real world charges.
We urge consumers to purchase these new comprehensive out of network policies when they become available next year.Surprise medical bills are the result of a number of factors, including insurance company greed.
It is an outrage that their malfeasance was ignored by the author of this one-sided article.
Andrew J. Kleinman, MD