Senate Passes Bill to Prevent Surprise Medical Bills

June 20, 2012

The New York State Senate today passed legislation to reduce costly and unexpected medical charges to health insurance consumers. The bill (S7745), sponsored by Senator Kemp Hannon (R-Nassau) establishes consumer protections to prevent surprise medical bills and ensures consumers have adequate access to necessary services.

“This proposal aims to establish balance and fair dealing to the participants involved in the financial aspects of a medical procedure,” Senator Hannon said. “The patient, the physician and the health plans have, in very recent years, each been subjected to unfair economic results. Primarily for those medical treatments not covered in-network, reports have been prevalent of high unexpected bills to patients, sudden decreases in reimbursements to physicians and surprisingly high charges to health care plans. This legislation seeks to address the  inequity in each area.”

Surprise medical bills result from a variety of insurance billing practices and are particularly pronounced in the emergency care setting. A 2012 report by the state Department of Financial Services detailed several incidents when patients who performed their due diligence in scheduling procedures with in-network providers later, and without the patient’s knowledge, had a non-network provider, specialist, or supporting staff perform or assist in the procedure. Instead of the expected insurance co-payment, the unexpected non-network charges often resulted in thousands of dollars.

In one case, a patient was surprised with a bill for $2,800 for half-an-hour of anesthesia provided by an out-of-network anesthesiologist during a routine colonoscopy provided by a participating provider.

Senator Hannon said, “In order to see a health care provider of their choice, some consumers select insurance policies which permit them to get care from ‘non-participating’ providers, but this can cause problems, such as surprise billings. My bill addresses this by requiring doctors, hospitals and insurers to make certain disclosures, and also protects consumers by ensuring their access to in-network services with the ability to go out-of-network if there are no in-network providers.  It will also protect the consumer from excessive charges for emergency services.”

The bill has been sent to the Assembly.