New York Can Stop Surprise Out-of-Network Bills!

Posted February, 24 2020 by Amanda Dunker

By Diana Zheng, Outreach and Education Coordinator at the Women’s Health Program at Community Catalyst

Shirley, a New York City resident, ended up with a $30,000 bill she didn’t expect after surgery for back pain in 2016. The cause? Bad information from both her insurance plan directory and her surgeon’s office that led Shirley to believe  he was in her provider network. (Learn more about this type of surprise bill here.)

Unfortunately, she wasn’t protected, even though New York State passed a “surprise bill” law in 2015 to protect New Yorkers from unexpected medical expenses. As Shirley’s story demonstrates,  there are still some loopholes in this law that create situations where patients like her could be stuck with an out-of-network bill when they are mistakenly informed that a provider was in their insurance network.

After seeing a doctor for excruciating back pain in 2016, Shirley was diagnosed with a bulging disc in her spine that required surgery. She wanted to be certain that her surgeon accepted her insurance, so she checked her insurance directory and with the doctor’s office before the procedure. Both sources assured her that the doctor was in-network. But much to her surprise, a month after the surgery, Shirley received a bill for $30,000. It turns out Shirley had been given outdated information – her surgeon had recently stopped accepting her insurance.

For the next three years, Shirley was stuck paying off an expensive medical bill because of other people’s mistakes. But Shirley is not alone – every year, many New Yorkers are faced with out-of-network medical bills because of this loophole in the surprise medical billing law.

A new bill, the Patient Medical Debt Protection Act (A8639/S6757), would close this loophole and protect patients from other challenges resulting from confusing or ambiguous medical billing practices (download a summary of the bill here, and read our first blog post in this series on unfair medical billing practices here). If approved by the New York State Legislature and signed into law by the Governor, the Patient Medical Debt Protection Act would ensure that patients will no longer be held responsible for surprise bills that result from health provider or health plan misinformation, and what happened to Shirley will no longer happen to any other New Yorker. 


Onemedall • Mar.06.2020 at 12:10:pm

To all who have worked on this topic we are deeply grateful that you have shared with us these important matters.

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