New York State Says “No” to Surprise Large Medical Bills

October 3, 2014

In September, the New York Times reported on a man who received an unexpected $117,000 medical bill from an assistant surgeon, he says, he never met. Peter Drier said he knew having neck surgery would be expensive and he researched the best he could through his insurance company to make sure he understood what an estimated cost could be.  It turns out the surgeon was called in to help, but Drier had no idea. On top of that, this surgeon was out-of-network, hence the incredibly large bill.

Cases like these are not uncommon. In fact, there are many other stories like Drier’s. You may even be able to relate! But the fact is, the difference between what in-network and out-of-network providers charge is quite substantial and cases like these contribute to the almost $3 trillion we spend in health care every year. This graphic from the New York Times gives us a glimpse of how much these charges can differ.

So how can this be avoided? Well, as a patient, if you are having surgery performed, it is highly unlikely you will sit up in the middle of the procedure to vet the doctors who are coming in to find out whether or not they are in your insurer’s network. But progress is being made to protect consumer-patients in New York. Starting in March, the state will require insurers to work with provider in order to let patients know if the doctors who will be treating them are in or out of their network. In addition, they must provide an estimated cost for using the out-of-network providers. This law also requires a patient’s permission for an out-of-network doctor to be used. If permission isn’t given, then that doctor will only be allowed to charge what an in network doctor would. This includes if a patient goes in for emergency care and is treated by an out-of-network doctor.

A law like this gives consumer-patients a little bit of reassurance in the midst of a system that keeps prices clouded in secrecy. While there is still a long way to go, this is a good start and a win for residents of New York.

Do you want to see a law like this implemented in your state? Let your representatives know! You can be part of the change to help protect your family and others!