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 Insurance	Women[5]	All New York[6]
Employer-Sponsored	61%	61%
Direct Purchase	7%	7%
Medicaid	24%	22%
Other	2%	2%
Uninsured	6%	8%

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.

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[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.

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