New York State and Medical Billing Issues
Would any consumer-driven industry be able to get away with this?
“Surprise medical bills occur when a consumer does everything possible to use hospitals and doctors that are in the consumer’s insurance plan, but nonetheless receives a bill from a specialist or other medical provider by whom the consumer did not know he or she would be treated, and who was outside his or her plan’s network of providers.
Worse, a relatively small but significant number of out-of-network specialists appear to take advantage in emergency care situations in particular, where the consumer has little choice or ability to “shop” for an appropriate provider. Too frequently, out-of-network specialists charge excessive fees — many times larger than what private or public insurers typically allow. In one example, a New Yorker who severed his finger in an accident went to participating hospital and ultimately received an $83,000 bill from a plastic surgeon who reattached the finger but – unbeknownst to the patient — was outside the insured’s network of providers.
The problem of surprise bills is not limited to emergency situations. They also can occur when a consumer schedules health care services in advance and an in-network provider, such as an anesthesiologist, is not available. In these instances, consumers are not told that the provider is out-of-network, not informed about how much the provider will charge, or not advised how much the insurer will cover. This lack of disclosure not only ill serves the consumer, but also undermines the efficiency of the health insurance market because consumers cannot effectively comparison shop for benefits or services”
This except from is part of a larger letter from Benjamin M. Lawsky, Superintendent of Financial Services for New York State, written to members of the New York State Legislature. You can read the letter here.
In any other industry, this would ALL be considered fraud.