NY Now Mandates Out-of-Network Insurance Coverage

ALBANY (AP) -

Starting next year, patients in New York will be protected from the surprise out-of-network medical bills that have pushed some toward personal bankruptcy.

The measure signed into law last week is scheduled to take effect April 1, 2015. It was proposed by the Cuomo administration, approved by the Legislature with some revisions and backed by consumer groups. It will require doctors and hospitals to more clearly notify patients about who is in their insurance networks and who is not.

“For older patients, the unexpected bills can break their delicate kitchen table economies,” said Beth Finkel, AARP New York state director. “This legislation is much needed in New York.”

Meanwhile, state insurance officials will write regulations on coverage and disclosures to patients and establish an arbitration process intended to settle related billing disputes between doctors and insurers, leaving patients out of them.

Financial Services Superintendent Ben Lawsky said his department now receives thousands of complaints annually from insured patients stuck with huge bills.

In emergencies, patients will be able to get treated by providers outside their insurer’s network and pay only their usual fees. They also will be protected from having to pay big out-of-network bills from doctors they weren’t told about.

“Because the bill is going to create a new set of disclosures for people to know if there’s going to be an out-of-network provider involved in their treatment and how much that will cost them, our hope is there’ll be far fewer of these kinds of disputes to begin with,” Lawsky said.

But Lawsky warned that the law is only intended to protect patients who try to stay in networks and won’t protect those who, for example, simply choose to visit an expensive doctor outside their network.