Women Report Surprise Bills Despite New York’s Landmark Law

Today, an extraordinarily diverse group of 61 organizations representing patients, religious leaders, labor organizations, people who are older, have disabilities, immigrants and people of color and more sent a letter to Majority-Leader Andrea Stewart-Cousins and Speaker Carl Heastie calling on elected officials to include the Ounce of Prevention Act (S1366 (2023) | A8441A (2022)) in the final State budget. The bill would reform the state’s Hospital Financial Assistance Law, enabling much-needed support to low-income families burdened by medical debt.

The letter is part of a united effort to end medical debt in New York state. You can show your support through our Phone2Action tool here.

Six percent of New Yorkers have been put into collections over medical bills, with numbers much higher for people of color in parts of the state. Nonprofit hospitals have sued more than 54,000 patients over medical debt they are unable to pay.

Many hospitals fail to offer meaningful financial assistance to their patients, despite receiving $1.1 billion dollars annually in state and federal funding to provide uncompensated care. Still others secure these funds despite failing the New York State Department of Health’s annual audits of their financial aid policies.

The Ounce of Prevention Act would add crucial patient protections to the existing Hospital Financial Assistance Law and increase the number of patients eligible to receive discounted care.

A copy of the letter can be found here.

Two new laws will protect New Yorkers from medical debt in 2023. The first bill, signed by Governor Hochul in November, stops all medical providers from garnishing patients’ wages or placing liens on their homes to collect medical debt judgments (S.6522A/A.7363A). The second bill, signed last week, reforms the practice of imposing facility fees by requiring hospitals and their affiliated providers to notify patients in advance if they charge facility fees and bans the fees for preventive care (S.2521C/A.3470C).

Property liens and wage garnishments were two of the worst consequences for patients sued by their hospitals or doctors after they could not afford medical care. The Community Service Society found that in just two years, New York’s hospitals placed 4,880 liens on patients’ homes. A study of just five hospitals revealed over 1,600 cases where patients’ wages were garnished. Both actions are especially troubling because the data on hospital lawsuits in New York suggests that many patients with medical debt were not adequately screened for financial assistance according to New York State law and IRS regulations (these apply to all hospitals in New York, which does not allow for-profit hospitals). Further, medical debt and all its consequences disproportionately effects people of color. The new law prevents ALL hospitals and other medical providers from taking these extreme actions against their patients—even veterinarians!

Notifying patients about facility fees, and banning them for preventive care, will make medical billing fairer. Facility fees are hospital overhead charges. The Affordable Care Act says that no one may be billed for preventive services, but facility fees still sometimes appear on patients’ bills because they are tied to the location of care, not the service. This law is the first in the nation that prevents facility fees for preventive care. The law also requires providers to notify patients ahead of time about the fee. This gives patients a chance to go somewhere else where they won’t be charged hospital fees for essentially outpatient care.  Providers already know your bill will include these fees before you walk in the door—it’s only fair that you do too! (You can hear more from patients about facility fees here and here).

FAQs: What Do Brand New #EndMedicalDebt Protections Mean for NY’ers?

  1. When do these changes take effect?

Both laws go into effect immediately.

  • Does either law apply retroactively?

Both laws are only prospective, not retroactive.

  • Can private doctors still place a lien on my home or garnish my wages?

No! The new law applies to money judgments arising from debt collection actions by either hospitals or health care professionals. 

  • Does the new law apply to all facility fees?

Yes! The new law requires ALL health facilities to disclose when a facility fee is added, and bars these fees for all preventative services—such as a screening mammogram.

  • What’s next for the #EndMedicalDebt campaign?

Next, we’re fighting to prevent medical debt before it starts. The Ounce of Prevention Act would require all hospitals in the state to adopt a uniform financial assistance application and policy to simplify the process for patients to apply and be eligible for financial assistance. It would also condition distribution of state Indigent Care Pool (ICP) funds to the hospital’s implementation and compliance with the policy.  

This summer, New York leaders passed two key pieces of legislation that would provide much-needed relief to patients burdened by medical debt:

  1. S.6522A/A.7363A: Prohibits a lien being placed on a person’s primary residence for medical debt judgments and prohibits wage garnishment for medical debt judgments.
  2. S.2521C/A.3470C: Requires hospitals to disclose additional “facility fees,” which cover overhead costs, before providing treatment; bans “facility fees” for preventive services.

The Governor has until the end of the year to sign these important bills into law – that’s just three months. 

55 organizations signed on to a letter sent to the Governor last week. Calling her office is key to making our message heard. That’s why we’re starting a push every Monday from October through December to call upon the Governor to take these important steps for patients and #EndMedicalDebt now.

Join us! Use the Phone2Action tool at cssny.org/EndMedicalDebt. Calling is simple: You will get a call from 516-701-2538, listen to a set of talking points, and then be connected to the Governor’s office.

Here’s what we recommend for your call:

Hi, I am [your Name] from [your town/city] and I want the Governor two sign two important bills to help End Medical Debt and relieve the burden that is crushing New Yorkers.
As soon as possible, we need Governor Hochul to sign into law:
– The bill to Ban Medical Liens and Wage Garnishments, S6522A/A7363 and
– The bill to Regulate Facility Fees, S2521C/A3470C.
Thank you.

Good luck and happy #MedicalDebtMonday!

Women are still struggling with surprise bills and making decisions about health care in the absence of meaningful price information, according to a focus group held by HCFANY. Several focus group participants described surprise bills as a big problem:

  • Three described bills that should have been prevented by New York’s Surprise Bill Law.
  • Some received out-of-network bills after being erroneously informed told by a provider or their insurance company that their provider was in-network.
  • Some also described surprise bills for telemedicine visits which the patient did not know were billable visits.

Participants also described problems gathering information about prices before receiving health care services. The focus group was part of a series investigating the effect of medical debt on different types of people across New York.

Women are more likely to have health insurance than men, but are also more likely to have medical debt. Nationally, 8.2% of women are uninsured compared to 10.2% of men, but 26.8% have past-due medical bills while only 20.8% of men do.[1] The type of coverage women have is similar to the coverage the general population has, other than slightly higher enrollment in Medicaid (see Table 1).  However, women may be more exposed to affordability challenges than men because of lower earnings and higher health care costs.  

Even in New York, where the gender pay gap is the lowest in the country, women only earn 89 cents for every dollar earned by men.[2] Lower pay may mean women enroll in coverage that has lower upfront costs, but less financial protection because of higher cost-sharing. The employer-sponsored plans women have access to may also come with higher costs than average because women are more likely to work in lower-wage jobs that may offer less robust health insurance.[3] The financial challenges women experience are compounded because women are more likely to seek health care for themselves or to interact with the health care system as a caretaker for others than men. This is true even when excluding pregnancy-related health care because women are more likely to seek treatment for chronic illnesses than men.[4]

Table 1. Health Insurance for Adults Aged 19-64 in New York State, 2019
Type of InsuranceWomen[5]All New York[6]
Direct Purchase7%7%

New York should do more to protect patients from unfair medical bills. The state should fully fund the Community Health Advocates program to support patients fighting surprise bills. It should ensure that surprise bills resulting from misinformation about a provider’s network status are covered by the Surprise Bill law. Legislation that would have done this failed to pass the State legislature last year. The State should also require providers to inform patients when a phone call will be billed as a telemedicine visit.

[1] United States Census, Selected Characteristics of the Uninsured in the United States (Table S2702), 2019: ACS 1-Year Estimates Subject Tables, https://data.census.gov/cedsci/table?q=United%20States&g=0400000US36&tid=ACSST1Y2019.S2702&hidePreview=true and Michael Karpman and Kyle J. Caswell, “Past-Due Medical Debt among Nonelderly Adults, 2012-15,” The Urban Institute, March 2017, http://www.urban.org/sites/default/files/publication/88586/past_due_medical_debt.pdf.

[2] New York State Department of Labor, “Closing the Gender Wage Gap in New York State: Pay Equity and Achievement,” April 2018, https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage/. https://www.governor.ny.gov/sites/default/files/atoms/files/Pay_Equity_Advancement_WageGap_.pdf.

[3] Michael Karpman and Kyle J. Caswell, “Past-Due Medical Debt among Nonelderly Adults, 2012-15,” The Urban Institute, March 2017, http://www.urban.org/sites/default/files/publication/88586/past_due_medical_debt.pdf

[4] Lois K. Lee, “Women’s Coverage, Utilization, Affordability, And Health After The ACA: A Review of the Literature,” Health Affairs, Vol. 39, No. 3: March 2020, https://doi.org/10.1377/hlthaff.2019.01361.

[5] Kaiser Family Foundation, “Women’s Health Insurance Coverage,” January 12, 2021, https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage/.

[6] Kaiser Family Foundation, “Health Insurance of Adults 19-64 (2019), available at https://www.kff.org/other/state-indicator/adults-19-64/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.