BILL NUMBER: S9069

SPONSOR: PERSAUD
 
TITLE OF BILL:

An act to amend the public health law, in relation to out-of-network
treatment disclosure for certain surgical procedures

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of the bill is to amend the public health law, in relation
to out-of-network treatment disclosure for certain surgical procedures.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. Subdivision 5 of section 230-d of the public health law, as
added by chapter 365 of the laws of 2007, is amended to read as follows:
every licensee performing inpatient and/or outpatient surgical care and
that requires pre-approval of surgical procedures by the patient's
insurance provider shall provide notice to the patient if all or a
portion of treatment approved is authorized to be rendered by a provider
              

that is not an in-network provider. Such notification shall be provided
to the patient by telephone call, email or text message at the time of
approval by the licensee and shall be confirmed by mail not more than
twenty-four hours after approval of the surgical procedure. If the
licensee fails to provide such notice to the patient at least forty-
eight hours prior to the procedure, the licensee shall cover the cost of
the procedure as though the services were rendered by an in-network
provider. The provisions of this subdivision shall not apply to any
surgical procedure performed within twenty-four hours after the insured
sustains the injury necessitating the surgical procedure.

 
JUSTIFICATION:

In 2017, Peterson-KFF Health System Tracker found out "the rate of out-
of-network charges for services at in-network inpatient facilities
ranged from 2% of in-network inpatient stays in South Dakota, Nebraska,
and Minnesota, to about a quarter or more in New York (33%), New Jersey
(29%), Texas (27%), and Florida (24%)". Surprise billing has been an
issue and continues to be problem now that insurance becomes progres-
sively complicated. For the most part, patients do not focus on whether
or not their surgical team is in-network; instead, they focus on the
outcome as well as making sure their surgeons are in-network providers.
Our middle-class residents, less fortunate New Yorkers, including black
and brown communities, are the ones facing tremendous financial hardship
due to surprise medical bills. When patients are not able to pay these
outlandish surprise medical bills, providers and hospitals add extra
fees before reporting them to the credit bureau. The harassment patients
face from credit companies is both unpleasant and stressful.

According to Fusion Anesthesia Solution: "10% of claims filed by physi-
cian anesthesiologists' fall into the surprise-billing category". It is
crucial to address these cases because not all surgical members that
performed these surgeries were in-network providers, and these patients
were not aware of it until they received the surprise bills.

One in five insurers is likely to receive surprise medical bills after
their scheduled surgery with in-network providers and hospitals. For
instance, a patient who went to a hospital covered by his or her plan is
likely to receive a surprise medical bill from a provider who was not
in-network. Anesthesia and pathology claims are likely to have a
surprise bill from an in-network hospital visit, which includes care
provided by an out-of-network provider. According to an analysis that
was done by Peterson-KFF Health System Tracker:" for people in large
employer plans, 18% of all emergency visits and 16% of in-network hospi-
tal stays had at least one out-of-network charge associated with the
care in 2017".

Anesthesiology is often within the category of services where surprise
billing occurs. Post-treatment patients are more likely to receive
surprise bills for reasons such as; a visit to a specialist or provider
office who is not in-network. When a patient goes to an in-network
hospital, some of its staff do not have a contract with that patient's
insurance.

Patients should not be forced to make decisions whether they should pay
their staggering surprise medical bills instead of providing for their
families, pay their mortgage, or rent. We are already dealing with
financial strains; therefore, receiving surprise medical bills will only
make matters worse.

This legislation aims to protect New York State residents from receiving
unexpected medical bills from out of network providers by mandating
hospitals and providers to notify patients with at least twenty hours
before their scheduled procedure.

 
PRIOR LEGISLATIVE HISTORY:

None

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law.