Blair Horner: The Unfinished Legislative Agenda

Over the next few weeks, you’ll be hearing about the accomplishments of the 2013 legislative session, which ended last week.  And lawmakers did approve some legislation, but one key consumer issue was left unaddressed.

Last year the Cuomo Administration issued a report examining the issue of “surprise medical bills.”   A surprise medical bill is when a consumer who has done everything reasonably possible to use in-network hospitals and doctors, receives a bill from a specialist or other provider whom the consumer did not or could not know was out-of-network.

For example, let’s say you were to go into the hospital for a needed surgery.  You then checked and found the hospital was covered by your plan and the surgeon was in your plan.  Good news, right?  The only personal financial exposure you should have is whether you have to pay a deductible or co-payment.

But in this hypothetical case, suppose that the anesthesiologist was not in your plan.  In some cases, the consumer has had to pay the full cost of an out-of-network provider who participated, in this case, in a surgery.  How were you supposed to know?  Is it fair that you are on the hook for payment of services that you had no idea was not covered?

I think we would all agree that consumers should be protected from such situations.  Yet, New York consumers are not.

Unexpected and, sometimes, excessive medical bills from out-of-network providers contribute to the growing problem of consumer medical debt, which continues to be a significant cause of personal bankruptcy.

This situation is especially difficult for cancer patients.  Cancer patients undergoing treatment often have care administered by numerous providers.  These patients are often uncomfortable from the treatments as well as the disease and are not in a position to carefully review the network status of every health care professional providing treatment.

The report put out by the Cuomo Administration found many cases where a consumer does everything possible to use an in-network health care provider for non-emergency services, but nonetheless receives a bill from a specialist (often a radiologist, anesthesiologist, or lab) whom the consumer did not know or realize was out-of-network.   Sometimes consumers were on the hook for thousands of dollars.

The report also found that too often out-of-network providers who provide emergency services – a circumstance where consumers cannot be choosy about whether the provider is in network – take advantage of the situation and charge fees well in excess of what Medicare or insurance would pay in network.  As a result, consumers are often left to pick up the difference through “balance billing” requirements.

Policymakers must enact measures to curb these anti-consumer practices.

And it was expected that consumers would get protections.  After all, the Administration prides itself on getting things accomplished and the report was released over a year ago.  In addition, all sides agreed that consumers should not be financially exposed to “surprise” medical bills.

Yet, the doctors’ lobby and the insurance lobby could not agree on an arbitration process to resolve the disputes in the “surprise medical bill” circumstances.  So nothing was done.  As a result, you could be on the hook and many New York consumers will get hit for this outrageous practice.

When you hear lawmakers crowing about their achievements for the session, ask them why they couldn’t get this issue done.

Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division.  His commentary does not necessarily reflect the views of the American Cancer Society.

The views expressed by commentators are solely those of the authors. They do not necessarily reflect the views of this station or its management.