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Legislative Memo

Lev Ginsburg
Director of Government Affairs
T 518.465.7511
www.bcnys.org

BILL:

S.7868-A (Seward) /A.10470 (Cahill)

Support

SUBJECT:

Out-Of-Network Emergency Charges

 

DATE:

June 9, 2016

 

The Business Council supports S.7868-A (Seward)/A.10470 (Cahill), which would add hospitals to the payment and settlement provisions of section 605 of the Financial Services Law.

In an effort to rein in the run-away costs of “surprise billing” and “balance billing” by doctors and hospitals, the Legislature, in the FY 2015 Budget, required multiple disclosures of anticipated costs by both insurers and providers. These included requiring insurers to disclose anticipated out-of-network costs for insured and prospective customers and requiring physicians to disclose real and anticipated costs when requested by patients.

The FY 2015 Budget also established a dispute resolution process to adjudicate out-of-network claims disputes, including balance billing, and created “hold harmless” protections for consumers who assigned benefits to out-of-network providers.   Addition, the Budget created a “loser pays” dispute resolution process between insurer and provider.

While current law requires health insurers to ensure that enrollees incur no greater out-of-pocket costs than they would have incurred with a participating provider when emergency services are received from a non-participating provider, the law only provides for an independent dispute resolution process for physician emergency charges and not for those billed by out-of-network hospitals.

Since hospitals are assured of receiving their billed charges regardless of how high they may be, as a result of not being included in the dispute resolution process, out-of-network hospital charges for emergency services are often excessively expensive. This legislation would rightly subject hospital charges for emergency services to the same dispute resolution process as other providers to help ensure that hospitals do not charge inappropriately high rates for their services to an otherwise completely captured payer.

As health care costs and consequently insurance premiums continue to rise by multiples of the inflation rate, everything that can be done to bend the cost curve would be welcome and needed relief for New York’s employers, employees and families.  This bill is a good start and The Business Council urges passage of S.7868-A (Seward)/A.10470 (Cahill).