CAPITAL NY: AT SENATE HEARING, DOCTORS ASK FOR OUT-OF-NETWORK CHANGES

 

    By Jessica Alaimo

    ALBANY—Doctors and patients pleaded for changes to out-of-network health care coverage, at a hearing convened on Monday by the State Senate’s health committee.

    “The confusion in the marketplace is beyond what I can comprehend and advise,” said ophthalmologist Dr. Patricia McLaughlin, who told lawmakers she’s losing patients due to insurance restrictions. “I’m looking at less than six months that I can stay in business and I’m very frightened.”

    Several physicians who testified at the hearing said access to out-of-network coverage has worsened in the last five years, and urged state lawmakers to intervene. The panelists argued that insurers were making it increasingly difficult access out-of-network coverage, and doctors said the low reimbursement rates for such coverage threatened their businesses.

    “The doctors need to earn a fair wage, the hospitals need to pay for expenses and the patients need to be held harmless,” McLaughlin said.

    Troy Oechsner, the state’s deputy superintendent for health, explained a provision that Governor Andrew Cuomo included in his proposed budget, which would remove the consumer from the insurance dispute-resolution process, leaving it up to the doctor and the insurer to settle disputes when the doctor is out-of-network.

    The executive budget provision would also require providers to make at least one out-of-network option available to consumers, and improve disclosures so consumers have a better idea the terms of their coverage.

    But the participants who testified urged the state to do more.

    “If all emergency fees were left to insurers to pay as they see fit, I would be out of business within six months,” said New York City neurosurgeon Dr. Michael Brisman.

    Chad Glaser of Buffalo, whose son was diagnosed with a rare liver disease, said his family has lived with the stress of getting his care covered.

    “You’re preparing your son to die based on the schedule of physicians who don’t specialize in the care my son needs,” Glaser said.

    Republican Sen. Greg Ball, after hearing Glaser, said insurance companies are like an “iron wall” preventing people from getting quality coverage.

    Glaser responded: “The insurance companies have allowed us to lose the heart and soul of medicine.” (ARTICLE)