Surprise: It’s an insurance bill!

New York’s Emergency Services and Surprise Bills

Today I’m writing about a New York state law that was passed earlier this year which is going into effect next year on April 1, 2015.  The law is known as the Emergency Services and Surprise Bills law and it’s intended to protect New York consumers from out-of-network medical services and surprise insurance bills.  As someone who has dealt with many other folks’ insurance claims over the years I think that this law is going to be great for individuals initially.

You read about this stuff all the time. People who have health insurance go to the ER and then get hit with massive bills due to the hospital allowing out-of-network doctors to operate out of their facilities.  You might even go to an in-network hospital, see your in-network doctor, and then get services from an out-of-network specialist.  Sometimes you hear of folks going to a doctor they found on their insurance company’s website, only to discover at a later date that the doctor was in-network  years ago, and was never removed from the insurance company’s list of providers.  And once in a while, you’ll hear of folks who need care from doctors so specialized that there aren’t any of those specialists in their insurance network.

Whenever someone asks me for advice on how to handle these issues, I always tell them the following:

Before any provider ever touches you, make to confirm that they are in your network.

Kind of crazy, asking a doc whether he participates in the MagnaPPO Plus ChoiceCare plan right before he puts on an your anesthesia mask, but hey, consumers need to be vigilant these days.

This new law is intended to protect the insured from those scenarios.  Instead of the onus being on the insured to cut some sort of deal with the doctors and hospitals, it now becomes the responsibility of the insurance companies to work with the medical providers.  This sounds great on the surface, but I wonder what the long term cost implications of this law will be. It probably means that the insurers are going to end up paying for claims that they didn’t intend to pay to begin with and/or have to spend extra time arguing and mediating claims with doctors and hospitals who aren’t in their network.

All of this amounts to more cost for the insurers, and guess who they pass those costs on to?  Yep, you guessed right.  Their plan participants who this law was designed to protect!

I’m also very interested to see how this law is handled for international health insurance claims.  Oh the amount of money I’d pay to see a claims resolutions specialist in the Midwest argue with a billing rep in Taiwan about negotiating a New Yorker’s hospital bill.

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