THE PATCH: BALL: INSURANCE INDUSTRY ‘SCREWING OVER’ PATIENTS

 

     

    By Tom Auchterlonie

    At a Thursday press conference calling for tighter regulation of insurance companies, state Sen. Greg Ball had choice words for the industry.

    “They’re selling a product without following through on the promises of that product, and they’re screwing over patients in, in the State of New York who are paying through the nose,” he said, adding that they are being placed in “financial Armageddon.”

    The event, held in front of Northern Westchester Hospital in Mount Kisco, was to reiterate a push for legislation that would add restrictions to how insurance companies treat out-of-network services. It would require insurers to disclose reimbursement formulas for out-of-network providers, place a ban of insurance plans that fail to provide out-of-network coverage, and disclose patients’ costs out of pocket for non-network situations.

    The bill is currently stalled in both houses of the state legislature, Ball explained, and is asking people to push their elected to officials to approve it before the legislative session ends.

    Joining Ball in support was Bedford Hills resident Maureen Kenney, whose was given a $99,000 bill in April 2011 because her husband, Philip, was treated at a non-network trauma center at Westchester Medical Center after suffering a rapid heart beat. Kenney still owes $56,000, she explained. The dispute between Kenney and her insurer, Excellus BlueCross BlueShield, is heading to a state appeals process after going through a grievance phase, she explained.

    “Excellus BlueCross BlueShield decided not to reimburse Westchester Medical Center for emergency procedures provided to my husband as advised by cardiac teams of both hospitals,” Kenney said.

    Kenney explained that because her husband was stabalized at the time of a transfer to Westchester Medical Center – he was first brought to Northern Westchester Hospital then was referred – his situation was not considered to be a medical necessity.

    Kenney declined to disclose her insurer’s name at a January press conference that Ball held for the bill. When asked why, she said, “Because they’ve eaten into hundreds of hours of my personal time with my family in trying to fight the bill.”

    Joe Redmond, a spokesman for Excellus, declined to comment on Kenney’s case, citing federal privacy law. However, he explained that Excellus is oppososed to the bill.

    “The out of network legislation is opposed by the Blue Cross and Blue Shield Plans of New York and by small businesses throughout the state because it would result in higher costs for consumers and hurt the quality of care.”

    Catherine Barbier, a New Jersey resident, was at the hospital on Thursday and recalled, to reporters, having a similar dispute as Kenney, in trying to get surgery for her husband, who fell and tore two discs, impairing his ability to walk. The cost relating to the surgery, she told reporters, is more than $265,000. Barbier explained that she is currently making a payment dispute in New York and has gone through New Jersey.

    Doctors from the area were on hand, arguing that insurance companies do not give fair reimbursement rates for physicians’ services.

    “Out of network reimbursement has been depressed so much in the last year or two,” said Dr. Thomas Lee, a neurosurgeon who is president-elect of the Westchester County Medical Society.

    “This legislation is extremely important,” said Dr. Bennie Chiles III, president-elect of the New York State Neurosurgical Society. “In effect, what we are seeing here in increased premiums, increased profits, for the insurance companies, with decreased benefits to the patients, decreased patient choice and decreasing patient access to care, and all these things need to be preserved.”

    In a policy statement written for the Blue Cross chapters and sent to Patch by Redmond, opposition to the legislation centers along a belief that it will raise costs for coverage and limit consumer choice, a decline of providers in network and higher out-of-pocket costs. (ARTICLE)