Medical care is costly enough without nasty surprises when the bills arrive. But every year, thousands of New Yorkers are slammed with big, unexpected charges from doctors and other health care providers who are outside their health insurers' networks.
It happens to people in emergencies who can't reasonably take the time to ask whether a doctor is in or out of network. But it also happens to patients who carefully seek in-network doctors and hospitals for elective procedures, only to find out after the fact that the anesthesiologist or radiologist or surgeon or other specialist tapped to assist in their treatment was an out-of-network provider. Such unexpected and sometimes excessive bills are the No. 1 consumer complaint heard by the state's Department of Financial Services, Superintendent Ben Lawsky said. The agency reviewed 2,000 of them in 2011.
Patients shouldn't be vulnerable to that kind of ambush and they won't be if a bill Gov. Andrew M. Cuomo has proposed becomes law. Consumers would be off the hook in all emergency situations. In nonemergency situations, patients who are not notified that a provider brought in to assist in their care is out of network also would be exempt from those unexpected charges. Additionally, insurers would be required to allow access to out-of-network providers without extra charges if there is no in-network provider with the training and experience to meet a patient's needs.
That means consumers would be on the hook only for the deductible and copays they signed up for when they bought their insurance.
Settling any surprise charges from out-of-network providers would be left to those providers and the insurance companies. If they are not able to reach agreement, the legislation calls for arbitration.
It's a practical approach to a problem crying out for a systemic solution. There should be no surprises for consumers.