Women Report Surprise Bills Despite New York’s Landmark Law

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.

On Friday, June 22, more than 70 HCFANY members from across the state gathered in Albany for our annual spring to learn about the Coalition’s ongoing and upcoming work to strengthen and expand health coverage all for New Yorkers and promote health equity. As you all know, it has been a very challenging year for health care, and we are very grateful to all who attended and engaged with us!

The agenda included an Advocates’ Panel during which we heard updates on HCFANY work on New York’s indigent care pool and safety net hospitals and the Coverage 4 All Campaign for immigrant coverage. We also discussed strategies for improving market stabilization and affordability in the individual market. Slides from the presentation are available here.

We were also honored to present our annual “Consumer Health Champion” Award to the grassroots groups, the “New York Grassroots Defenders of Health Care” who have been so instrumental in the fight to defend the ACA and Medicaid here in New York. Awardees included: ACR Health, “Faso Friday,” Long Island Save Our Health Care Alliance, NY-11 for Health Care, Rochester ADAPT, and Saratoga Progressive Action.

The meeting concluded with discussion and planning groups on federal advocacy, protecting New York State’s individual market, and preserving and expanding immigrant coverage.

RWV National Women's Health Month 2018 GraphicGuest post by Jessica Pierson, graduate student intern with Raising Women’s Voices-NY.

National Women’s Health Week kicked off on Mother’s Day and will continue through Saturday, May 19th. Raising Women’s Voices-NY is celebrating by hosting activities and providing resources to promote women’s health throughout the week.

On Tuesday, May 15th, Raising Women’s Voices is hosting a Twitter Chat from 2 to 3 p.m. to discuss women’s health using the hashtag, #HerHealth. Organizations from around the country will be sharing information on a range of women’s health topics, such as what to expect at a well-woman visit, black maternal health disparities, how to take advantage of cost-free preventive services, reproductive health care for trans folks and how to navigate the health care system.

National Women’s Health Week is a great time to remind women to schedule their annual well-woman visit, which is free with their health insurance. RWV has created a flyer outlining key women’s preventive services for health organizations to use in promoting National Women’s Health Week. Navigating the health system can be difficult and confusing. RWV’s flyer can help simplify women’s experiences with the health system by explaining that services such as birth control, STI/HIV testing, blood pressure tests, flu shots and help quitting smoking are all included in a free well-women’s visit! The flyer also explains how to schedule an appointment, what to expect at the appointment and how to get the most out of the visit. RWV suggests distributing these customizable flyers at bus stops, laundromats or other local spots in order to reach women in every corner of your community.

Looking to promote women’s health in your area? RWV suggests amplifying National Women’s Health week by hosting an open house or community care night, holding a panel discussion or press events.

The Affordable Care Act improved access to women’s health services, but still millions of women are uninsured. Although Open Enrollment for health insurance through NY State of Health doesn’t start again until November, women may qualify for a Special Enrollment Period of 60 days if they experience a qualifying life event. Examples include losing your job-based health insurance, getting married, having a baby, adopting a child or, in New York only, becoming pregnant. Medicaid, Essential Plan, and Child Health Plus enrollment continue year-round. If you think you might qualify for enrollment, contact the Community Health Advocates hotline at 888-614-5400.

It is imperative that we celebrate National Women’s Health Week by helping women get insured and utilize their insurance wisely to optimize their health and well-being, and catch health problems early. RWV hopes you will join us for our Twitter Chat on May 15 and help us promote women’s health all week long!

C4A LogoGuest post by Claudia Calhoon, MPH, Director of Health Policy at the New York Immigration Coalition.

On Wednesday, December 13, the Assembly Committee on Health, the Assembly Puerto Rican/Hispanic Taskforce, and the Assembly Taskforce on New Americans convened a public hearing on Immigrant access to healthcare.  Coverage 4 All, a campaign of Health Care For All New York led by the New York Immigration Coalition and Make the Road New York was instrumental in advocating for the hearing. The campaign’s goal is to expand insurance eligibility to all New Yorkers to reduce disparities in coverage.   Barriers to coverage are just one of the many current threats to immigrant health access and quality.

Agencies that provided testimony included the New York State Department of Health, the New York City Mayor’s Office for Immigrants Affairs, New York City Department of Health and Mental Hygiene, and New York City Health + Hospitals.  In addition, fifteen individuals from a range of social service, advocacy, health care, and community settings spoke about the impact of the federal administration on immigrant mobility, health utilization, coverage eligibility, and enforcement of language access regulation. Amid a federal landscape hostile to immigrants, New York State programs and protections are increasingly important.

Critical areas of particular attention included making sure that new mothers know they can safely continue to enroll in Medicaid and get prenatal care regardless of their immigration status, and continue to use the Women’s Infants, and Children (WIC) Food and Nutrition services. Another area of common interest among advocates was the opportunity that the state has to expand the Child Health Plus insurance program to cover young adults up to age 29 at a cost of $81 million.  Dr. Alan Shapiro, co-founder of Terra Firma, which works with unaccompanied minors, noted that health needs don’t end when young people turn 19.  These individuals “still have comprehensive primary care needs. They need access to immunizations, urgent care, sexual and reproductive health services.” The Child Health Plus Expansion is part of Health Care for All New York’s policy agenda, and the key priority of the Coverage 4 All campaign.

Hearing testimony from multiple stakeholders also highlighted the critical nature of improving enforcement of language access regulations, addressing mental health needs of immigrant communities subject to heightened stress under enhanced federal immigration enforcement, and ensuring that safety net hospitals have the revenue they need to care for all New York State residents.