Relief in on the way for New Yorkers slapped with big, unexpected charges from out-of-network doctors.
A much-needed state law that will require doctors and insurance companies to settle those bills -- without saddling patients with the costs -- takes effect on April 1, 2015.
Surprise bills have often arrived after medical emergencies when patients and relatives couldn't reasonably have inquired whether the doctors treating them were in or out of their insurer's network. Shock has also arisen from elective-procedure bills even after patients dutifully sought in-network doctors and hospitals, only to learn later that a surgeon or radiologist was from out of their network and not fully covered.
Unexpected charges in such circumstances were the No. 1 consumer complaint heard by the state's Department of Financial Services. Agency Superintendent Benjamin Lawsky was determined to change this.
A new law enacted last week will take patients off the hook for those charges in all emergency situations. The same goes for patients who got elective treatment and weren't told in advance that an assisting specialist was out of network. That's a powerful incentive for doctors and insurers to provide clear and timely information. Patients also will be allowed to go out of network without extra charges if there is no in-network provider with the skills and experience to meet their medical needs. There will be an arbitration process to help doctors and insurers settle billing disputes.
Until the law takes effect next spring, however, patients who get unexpected bills from out-of-network providers can call the Department of Financial Services for help to resolve the problem.
Medical bills free of costly surprises are a good reform you can take to the bank.