New York State

Insurance

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Contact:

Public Affairs

(212) 480-5262

www.ins.state.ny.us

Eric R. Dinallo   Superintendent of Insurance  25 Beaver Street  New York, N.Y. 10004

ISSUED 08/20/2008 FOR IMMEDIATE RELEASE

 

Contact: Insurance Department David Neustadt 212-480-5265
  Health Department, Claudia Hutton, 518-474-7354 ext. 1

INSURANCE AND HEALTH DEPARTMENTS TO HOLD JOINT HEARING ON OUT-OF-NETWORK INSURANCE COVERAGE

October public hearing in Albany to examine “surprise” bills from out-of-network doctors when patients go to an in-network hospital.

In response to complaints from consumers who did everything they could to use in-network doctors, but nonetheless received surprise bills from specialists whom the consumers did not know were out-of-network, the Insurance Department will hold a public hearing with the Department of Health, Insurance Superintendent Eric Dinallo announced..

The hearing – scheduled for October 7, 2008 in Albany – is designed to get the views of all interested parties on multiple issues surrounding this problem, including disclosure, referrals and emergency services.

“Consumers are put in an impossible position,” Dinallo said. “They follow the rules of their health insurers and receive care from a participating doctor and hospital, believing that all related services – such as laboratory, anesthesiology and pathology – will be covered at the in-network rate. Despite their best efforts to stay in-network, consumers are often shocked to get a big bill because the anesthesiologist or pathologist is not in their health plan’s network.”

Department of Health Commissioner Richard F. Daines, M.D., said, "The confusion over which doctor belongs to which network serves the patient poorly and leaves a doctor at risk of performing services for which he or she might not be paid. The Department of Health supports the public hearings, and looks forward to hearing from consumers. Patients need protection from unexpected costs, especially during health emergencies."

The Insurance Department has received numerous complaints from consumers who received care from a participating doctor or hospital, yet related specialty services were either denied or covered as out-of-network. Often, the consumer had no choice in selecting the specialist or may not have been told the specialist was non-participating.

One consumer contacted the Insurance Department because her health plan had pre-authorized a surgical procedure at a participating hospital, but she received a $1,500 bill from the anesthesiologist whom she encountered only immediately before the surgery. Upon contacting her health plan, she was advised that the anesthesiologist was a non-participating provider and would be paid at the out-of-network rate of $1,000. As a result, she owed the difference, $500. This is known as “balance billing.” This was despite the fact that she obtained pre-authorization and was not made aware the provider was non-participating. The consumer was ultimately put into collections by the anesthesiologist for the difference between the amount her health plan paid and the amount the anesthesiologist charged.

These types of issues are not limited to cases when a consumer is able to schedule health care services in advance. In fact, these issues are even more prevalent in emergency situations since a consumer is often unable to choose where to receive services. And even if a hospital participates in a health plan’s network, there is no guarantee that the emergency room physician or the anesthesiologist will also participate with the health plan. In such cases, consumers may be faced with exorbitant bills for the emergency services for which their health plan will only pay a portion.

The Insurance Department and Department of Health are considering statutory and regulatory changes to address these issues and would like to receive input from consumers, health plans, providers and other interested parties.

The public hearing is scheduled as follows:

Date:

Tuesday, October 7, 2008
Time: 10:00 AM
Location: Empire State Plaza, Meeting Room 1, Albany, New York

The hearing is open to the public. Interested parties may testify at the hearing, or submit written comments to be included in the hearing record. Any person wishing to testify should contact the Insurance Department’s Public Affairs Bureau at (212) 480-5262. Oral testimony will be allowed for up to 10 minutes per person.

Written comments for the hearing record may be submitted to Coverage of Health Care Services Hearings, Public Affairs Bureau, New York State Insurance Department, 25 Beaver Street, New York, NY 10004, or e-mailed to PublicHearingsComments@ins.state.ny.us with the subject line “COVERAGE OF HEALTH CARE SERVICES.” Comments will be accepted by the Department for up to 15 business days after the public hearing.

The hearings will be webcast live. Information on the hearings, including directions to the locations and how to watch the webcast, is available on the Department’s website at www.ins.state.ny.us. Additional information about the hearings is available from Michelle Jeffers at (518) 474-4567 or by e-mail at .

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