http://www.bloomberg.com/news/2014-...bPNQ3Tc-y2XOX5F3gJ2Y5rqAwsNYZQ&_hsmi=12426988
Hospital patients in New York are the latest in the nation to gain legal protection against unexpected bills from doctors who won’t accept their insurance.
New York this week extended patient protection laws to restrict out-of-network providers from “balance-billing” consumers for emergency care or when patients can’t choose their doctors. Balance-billing occurs when health workers who don’t accept a patient’s insurance try to collect the difference between their charge and the insurer’s reimbursement.
New York is one of 13 states that have restrictions on out-of-network balance-billing, according to theKaiser Family Foundation. Patients most often receive these surprise bills in emergency cases, when they can’t choose the doctors who treat them. In California, a 2007 survey conducted before the state implemented patient protection laws found 1.8 million insured residents who visited emergency rooms over two years faced extra charges, according to the California Health Plan Association.
“It’s a pretty good bet that if you’re hospitalized or having any kind of surgery, somebody along the way who touches you or your slides or films will not be in network,” said Karen Pollitz, a senior fellow at theMenlo Park, California-based Kaiser foundation.
New Yorkers previously were protected only from out-of-network ambulance bills and, for individuals in health maintenance organizations, in the ER. Under the new law, beginning next year all medical providers will have to notify patients before treatment if they don’t take their insurance. If not, patients will be required to pay only a regular co-pay as if the provider was in network.
Broken Leg
Balance-billing happened to Abby Ives, a therapist and clinical social worker from Ossining, New York, when she fell in her front yard on June 24, 2012, and shattered a bone in her right leg.
As a health-care provider, 61-year-old Ives knew the importance of insurance.
“As I was laying in the front yard, I told my husband, ‘Honey, get the insurance card, we’re going to need it,’” she recounted in a telephone interview.
The ambulance took her to Phelps Memorial Hospital Center in Sleepy Hollow, New York, which was covered by her insurance through Empire Blue Cross Blue Shield. Ives underwent surgery, then X-rays revealed her left leg was also broken, so she had a second surgery. During her monthlong stay in the hospital, she said she wasn’t told that many of the providers treating her weren’t included in her insurance plan.
Not Covered
Ives was shocked when, after she was discharged, Empire notified her that both surgeons, the hospitalists who coordinated her care within the hospital and the cardiologists who read her electrocardiograms weren’t part of her coverage plan. One surgeon sent her a bill for $13,000, the hospitalists charged $1,500, and two electrocardiograms were an additional $100 each.
“My reaction is not printable,” she said. “I’m a provider, I see patients and bill insurance companies, I’m supposed to know how this works, but how did they do that to me?”
To pay the bills, Ives said she would have to reach into her and her husband’s retirement funds. She appealed to the surgeon’s billing staff repeatedly, she said, before the surgeon agreed to accept the insurance company’s out-of-network reimbursement of $20,000 and stop pursuing Ives for the balance of $13,000.
As for the hospitalists and cardiologists, “I just paid them,” Ives said. “I wanted to be done, for them to go away.”
Outrageous Bills
WellPoint Inc. (WLP)’s Empire Blue Cross Blue Shield, Ives’ insurance, supports provisions in the new law that “will help protect consumers from outrageous, unexpected medical bills,” Sally Kweskin, a spokeswoman, said in an e-mail.
Phelps Memorial spokeswoman Tina Dorfman said in an e-mail that the hospital “has almost 500 physicians on staff, and only a fraction are employed by the hospital. The remaining physicians take various other combinations of insurance plans. Administratively it’s impossible for a hospital to have current information at all times about which insurance plans every physician is accepting.”
The need to protect consumers like Ives is growing as the Patient Protection and Affordable Care Act, known as Obamacare, extends insurance to millions of Americans, said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York.
Hospital patients in New York are the latest in the nation to gain legal protection against unexpected bills from doctors who won’t accept their insurance.
New York this week extended patient protection laws to restrict out-of-network providers from “balance-billing” consumers for emergency care or when patients can’t choose their doctors. Balance-billing occurs when health workers who don’t accept a patient’s insurance try to collect the difference between their charge and the insurer’s reimbursement.
New York is one of 13 states that have restrictions on out-of-network balance-billing, according to theKaiser Family Foundation. Patients most often receive these surprise bills in emergency cases, when they can’t choose the doctors who treat them. In California, a 2007 survey conducted before the state implemented patient protection laws found 1.8 million insured residents who visited emergency rooms over two years faced extra charges, according to the California Health Plan Association.
“It’s a pretty good bet that if you’re hospitalized or having any kind of surgery, somebody along the way who touches you or your slides or films will not be in network,” said Karen Pollitz, a senior fellow at theMenlo Park, California-based Kaiser foundation.
New Yorkers previously were protected only from out-of-network ambulance bills and, for individuals in health maintenance organizations, in the ER. Under the new law, beginning next year all medical providers will have to notify patients before treatment if they don’t take their insurance. If not, patients will be required to pay only a regular co-pay as if the provider was in network.
Broken Leg
Balance-billing happened to Abby Ives, a therapist and clinical social worker from Ossining, New York, when she fell in her front yard on June 24, 2012, and shattered a bone in her right leg.
As a health-care provider, 61-year-old Ives knew the importance of insurance.
“As I was laying in the front yard, I told my husband, ‘Honey, get the insurance card, we’re going to need it,’” she recounted in a telephone interview.
The ambulance took her to Phelps Memorial Hospital Center in Sleepy Hollow, New York, which was covered by her insurance through Empire Blue Cross Blue Shield. Ives underwent surgery, then X-rays revealed her left leg was also broken, so she had a second surgery. During her monthlong stay in the hospital, she said she wasn’t told that many of the providers treating her weren’t included in her insurance plan.
Not Covered
Ives was shocked when, after she was discharged, Empire notified her that both surgeons, the hospitalists who coordinated her care within the hospital and the cardiologists who read her electrocardiograms weren’t part of her coverage plan. One surgeon sent her a bill for $13,000, the hospitalists charged $1,500, and two electrocardiograms were an additional $100 each.
“My reaction is not printable,” she said. “I’m a provider, I see patients and bill insurance companies, I’m supposed to know how this works, but how did they do that to me?”
To pay the bills, Ives said she would have to reach into her and her husband’s retirement funds. She appealed to the surgeon’s billing staff repeatedly, she said, before the surgeon agreed to accept the insurance company’s out-of-network reimbursement of $20,000 and stop pursuing Ives for the balance of $13,000.
As for the hospitalists and cardiologists, “I just paid them,” Ives said. “I wanted to be done, for them to go away.”
Outrageous Bills
WellPoint Inc. (WLP)’s Empire Blue Cross Blue Shield, Ives’ insurance, supports provisions in the new law that “will help protect consumers from outrageous, unexpected medical bills,” Sally Kweskin, a spokeswoman, said in an e-mail.
Phelps Memorial spokeswoman Tina Dorfman said in an e-mail that the hospital “has almost 500 physicians on staff, and only a fraction are employed by the hospital. The remaining physicians take various other combinations of insurance plans. Administratively it’s impossible for a hospital to have current information at all times about which insurance plans every physician is accepting.”
The need to protect consumers like Ives is growing as the Patient Protection and Affordable Care Act, known as Obamacare, extends insurance to millions of Americans, said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York.
