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Cuomo’s Superintendent of Financial Services, Benjamin Lawsky, issued a detailed report that he says reveals that many New Yorkers are getting stuck with unexpected medical bills, totaling as much as tens of thousands of dollars due to loop holes in the out-of-network provider regulations.
Lawsky explains how the problem occurs. He uses the example of someone getting shoulder surgery, and then finding out that the radiologist or a lab used for lab work is out of his or her network.
“New Yorkers around this state are getting stuck with these huge out of network bills that are a surprise to them,” Lawsky said.
Sherry Tomasky, with the American Cancer Society, says it’s a problem that often plagues cancer patients, who undergo many tests and see numerous health care professionals during treatment. Tomasky says she even encountered an unexpected out-of-network medical bill herself, when she sought a cancer screening, and her mammogram showed a suspicious lump. Even though her test results were sent to a radiologist at the same medical campus where she worked, she found the analysis was out of her health care provider network.
“After protesting, I still, at the end of the day, had to pay the bill,” said Tomasky, who said she paid it off in installments.
Superintendent Lawsky says his investigation also found that patients are also sometimes saddled with excessive bills for out-of-network emergency medical care. The probe found some out-of-network specialists take advantage of that, and charge the patients more than they would normally charge an in network patient.
Lawsky he’ll be working with the insurance industry in the coming weeks to craft a bill to close some of the loopholes, and require that insurance companies, doctors, and other health care providers disclose to patients in advance when a provider may fall out of their insurance policy network.
But, he says, the Administration does not view the insurance industry as an adversary.
“They’re not the bad guys,” he said.
The response from the health insurance industry was positive. In a statement, the lobby group, New York Health Plan Association, said the Admisntration “shines a bright light” on an on going problem, but also that they hope any solution does not end up raising rates for health care premiums even higher.
No timetable has been set yet for a completed bill.