Cuomo to crack down on excessive out of network medical bills

New York Financial Services Supt. Lawsky explains report. PHOTO: Karen DeWitt / NY Public Radio

The Cuomo Administration is cracking down on insurance companies and health care providers who stick patients with unexpected out of network service bills.

Cuomo’s Superintendent of Financial Services, Benjamin Lawsky,  issued a detailed report that he says shows that many New Yorkers are getting stuck with unexpected  medical bills totaling as much as tens of thousands of dollars,  because of 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 their 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 they say 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.