New Yorkers were protected from $400,000,000 in unfair, out-of-network bills between 2015 and 2018 because of our surprise bill law. New York passed the law in 2015 after the state received hundreds of complaints over the years from people who had done everything they could to use in-network providers, but still ended up with huge bills.
The law is especially effective for people being billed for emergency services. Providers cannot bill patients for out-of-network emergency services that the patient could not avoid. Neither the provider nor the plan may charge patients for services in excess of the deductible, copay, or coinsurance amounts they owe according to their plan agreement. Patients are also protected in non-emergency situations when they are at an in-network hospital or ambulatory center and there is no in-network physician available, they are taken care of by an out-of-network provider without their knowledge, or an unforeseen medical issue arose that required unplanned medical care.
The patients’ insurance company and the provider have to figure it out without involving the patient whatsoever. In New York they do that through a third-party in a process called independent dispute resolution (similar to baseball arbitration). The law not only helps patients avoid unfair bills, it helps keep insurance premiums down because the dispute resolution process prevents insurers from having to pay excessive charges. And now that this process is in place, providers working in hospitals have more incentive to join insurance networks and work out a system of payment through a regular network agreement. That means fewer surprise bills overall.
Our surprise bill law is missing some pieces. One of the most common types of surprise bills occurs after patients have been told by their plan and provider that the provider is in-network. If that information is wrong, the patient has no recourse. New York can fix that during this year’s legislative session.
Another problem is that states can only regulate some plans. Self-funded plans, which are usually plans people get through employment at very large companies, can only be regulated by the federal government. DFS recently required insurance companies to include what type of plan you have on every insurance card, which will help. The law also might not help you if your plan was issued outside of New York. New York has great regulators that do everything they can to protect consumers – but we need to make sure we have leaders in Washington that also care about patients and access to health care.
What should you do if you have a surprise bill? Ask for help! It can be hard for people to know if the law covers their bills or not. Community Health Advocates is a state program that connects you to counselors who can help figure it out – for free, and regardless of what insurance you have (if any). The counselors look at medical bills every day, so they can save you a lot of time – and maybe a lot of money! Their helpline number is 212-614-5400.
New York City health care leaders called for more city and state efforts to address health care affordability during a panel discussion this morning at the Community Service Society of New York. Speakers including Dr Mitch Katz, NYC Health + Hospitals President and CEO; Rodrigo Sanchez-Camus, Director of Legal Services at NMIC; Mark Levine, Chair of the NYC Council’s Health Committee; and Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society of New York. David Sandman, President of the New York State Health Foundation, moderated. (You can view a recording of the event here).
Panelists discussed solutions including a single-payer system, a city-funded consumer assistance program, and an overhaul of medical billing practices that leave patients paying more than they owe out of confusion and fear. The event also served as a launch party for a new grassroots effort called We the Patients (read more here) that gives New Yorkers as opportunity to advocate against unfair health care practices.
The panel was inspired by a survey (available here) which found that 50 percent of people in New York City had taken steps like cutting a pill, not filling a prescription, or skipping a treatment because they could not afford it. Most of the people surveyed had insurance.
Those results show that New Yorkers need help using their health insurance and fighting unfair medical bills. New York pioneered a model for providing that help called the Managed Care Consumer Assistance Program (MCCAP). MCCAP provided technical assistance to people enrolled in Managed Care Plans, including direct advocacy with insurance plans and legal assistance for things like inappropriate claims denials. Today all New Yorkers have access to that assistance through the Community Health Advocates and Navigator programs. Panelists suggested that the City provide its own funding to boost those services because of the disproportionate impact the affordability crisis has on city residents.
The panel also discussed the role of hospitals and unfair billing practices in New York’s health care affordability crisis. One of the examples included an almost $300 facility fee charged to a person for what should have been a free preventive mammogram because it was provided in a hospital-affiliated practice. Some of the solutions discussed include eliminating the use of facility fees, requiring consolidated and standardized bills, and requiring that all hospitals use standard financial liability waivers so that patients are protected from signing away their rights before receiving medical care. We the Patient’s first petition focuses on seven common billing practices that result in patients owing more than they should (you can sign the petition here).
In 2019 half of New Yorkers said they could not afford basic care like prescriptions or recommended tests. New Yorkers told us they are taking drastic steps to get health care, like cutting their pills in half or using up all of their savings. Yet the budget does almost nothing to expand health coverage or make health care more affordable!
There is still time for New Yorkers to demand budget action from state leaders – but not much! See below for action steps on three priority issues you can take over the next few days and for contact information.
Community Health Advocates (CHA)
CHA helps New Yorkers fight back when insurance companies deny care or send inappropriate bills. It has provided free help to uninsured and insured New Yorkers, no matter what type of coverage they have, since 2010 and in that time has saved consumers over $35 million. Call your New York Assemblymember and Senator and say:
- CHA deserves to be fully funded at $6.5 million.
- New Yorkers deserve independent consumer assistance programs like CHA. The Assembly’s language establishing this program in state law MUST stay in the final budget.
Fair Hospital Funding
The budget preserves a status quo in which funding meant for hospitals that help low-income New Yorkers is given to hospitals that neither provide that care nor struggle financially. More information is available here. Call your New York Assemblymember and Senator and say:
- End the transition collar that starves and destabilizes hospitals that take care of low-income and Medicaid-insured patients. By continuing the collar, the Assembly protects hospitals from losing charity care money whether or not they provide charity care – this language must be removed from the final budget!
- A6677 was created by community hospitals and advocates and would fix remaining inequities in the distribution of charity care funds. This bill should be passed so that our true safety net hospitals get the support they deserve and so state resources are not wasted on profitable hospitals that don’t serve low-income New Yorkers.
A5974/S3900 would allow all low-income New Yorkers, regardless of immigration status, enroll in the Essential Plan. Over 200,000 New Yorkers would be able to get health coverage if this bill passed.
- Tell your Senator that you support expanding the Essential Plan to all New Yorkers and ask them to co-sponsor S3900. You can see who has already done so here. Don’t forget to thank those who have done the right thing already! You can also call members of the Senate Health Committee and say that you want them to move on the bill as soon as possible.
- Tell your Assemblymember that you support expanding the Essential Plan to all New Yorkers and ask them to co-sponsor A5974. Current co-sponsors are listed here. You could also call members of the Assembly Ways and Means Committee and say that you want them to move on the bill as soon as possible.
- If you represent an organization you can submit a memo of support to the Senate Health Committee and the Assembly Ways and Means Committee. A template and contact info are available here.
A3316/S1809 would preserve Medicaid eligibility for immigrants threatened with the loss of Temporary Protected Status. People who lose TPS will lose their ability to work or enroll in Medicaid. New York should give them a health care safety net.
- Tell your Senator that you support S1809 because you want to protect TPS holders from losing health coverage, and ask them to co-sponsor the bill. You can see the current co-sponsors here. You can also tell members of the Senate Health Committee that you support S1809 and want to see the bill taken up as soon as possible.
- Tell your Assemblymember that you support A3316 and ask if they are willing to co-sponsor. You can see the current list of co-sponsors here. You can also tell members of the Assembly Ways and Means Committee that you support A3316 and want to see the bills taken up as soon as possible.
- If you represent an organization you can submit a memo of support to the Senate Health Committee and the Assembly Ways and Means Committee – click here for a template and contact information.
Who to Contact
- Hon. Andrea Stewart-Cousins, Majority Leader: 518-455-2585.
- Hon. Gustavo Rivera, Chair, Committee on Health: 518-455-3395
- Find your Senator here.
- Health Committee members listed here.
- Hon. Carl Heastie, Assembly Speaker: 518-455-3791
- Hon. Richard Gottfried, Chair Committee on Health: 518-455-3395
- Find your Assemblymember here.
- Ways and Means members listed here.
Late last week, a Health Affairs article described a new study on “surprise” medical bills. In New York State, “surprise bills” are bills from an out-of-network provider or out-of-network lab that a patient did not choose. These surprise out-of-network bills can lead to catastrophic medical debt and anxiety for consumers. The study found that 20 percent of hospital admissions that originated in the emergency department in 2014 were likely to lead to a surprise bill. In New York State, 30 to 40 percent of hospital inpatient admissions from the emergency department had the potential to result in a surprise medical bill.
In 2015, New York became the first state to enact legal protections to consumers facing surprise out-of-network bills. The Emergency Medical Services and Surprise Bills Law holds consumers harmless when they are treated by an out-of-network provider at an in-network hospital, or they are referred by an in-network provider to an out-of-network provider without their written consent.
New York’s surprise bills law also ensures that consumers who have New York State-regulated insurance no longer have to negotiate bills on their own. Insurance plans and providers can negotiate through an independent third party in a process called Independent Dispute Resolution (IDR).
For New Yorkers who get insurance through a job, through the Marketplace, or for New Yorkers who are uninsured, the Surprise Bill law provides they can dispute the bills through IDR.
If you think you have received a surprise bill, you can contact Community Health Advocates (CHA) for assistance.
Also, check out these great resources from CHA on surprise bills and emergency services: