Albany, N.Y. – 01/27/2014 – The New York Senate Health Committee hosted a roundtable discussion on Monday to discuss out-of-network insurance coverage. Chairman Kemp Hannon (R – Nassau County), Health Committee Member Senator Greg Ball (R, C, I – Patterson), and other Committee Members focused on legislative proposals (including S2551/A7253 and S6207/A8494) that would enable New Yorkers to continue to be able to purchase health coverage that enables them to see the physician of their choice.
The legislation would make the cost of health care more transparent and protect consumers from exorbitant surprise medical bills. Participants of the roundtable included physicians and consumers with firsthand experiences dealing with out-of-network issues.
“I commend the Governor for putting forth legislation in his proposed budget to address out-of-network coverage and look forward to working with him to enact meaningful reforms,” said Senator Hannon. “The fact that individuals seeking insurance coverage through the exchange cannot find a policy that offers out-of-network coverage in most areas of the state is alarming and should be part of our reform effort.”
“We have multi-billion dollar insurance companies that are seeing record profits, a healthcare system that is broken and forcing doctors out of this state in droves, and blue-collar families that are being held over the barrel by insufficient networks and coverage,” said Senator Greg Ball. “This is reaching a critical level, and I thank the Governor for at lease initially addressing the issue in this year’s budget. That said, the devil is in the details, and there is much collaboration that still must be done to properly, adequately and finally solve this critical issue. Our families simply cannot wait another year for both houses to pass this important bill.”
Both Chad Glaser of Buffalo and Maureen Kenney of Bedford Hills spoke about how their families have been wronged by the health care system. Chad Glaser’s son was born with a rare liver disease that required out-of-network health care services and Maureen Kenney’s husband was transported to an out-of-network hospital during an emergency heart operation and woke up to a $99,000 bill.
Senator Hannon and Senator Ball’s legislation, S2551 that passed the Senate in 2013 and 2012, would address these concerns by assuring that consumers can purchase health coverage that pays for the true costs of medical care they will face. Importantly as well, the bill would require certain disclosures by health care providers, hospitals and insurers to prevent surprise medical bills and assure patients have greater information regarding the scope of their coverage. Their bill would also protect consumers by ensuring they have adequate access to in-network services, with the capability to go out-of-network in the event there is no in-network provider. Furthermore, this legislation would protect consumers from excessive charges for emergency services. Senate Bill 6207 would require that insurers provider individuals purchasing insurance have the option to purchase out-of-network coverage.
Maureen Kenney of Bedford Hills is just one of numerous New Yorkers that have purchased premium insurance plans, only to be stuffed with the bill in their time of need.
In April of 2011, Kenney’s husband was treated in the emergency room at Northern Westchester Hospital, which is an “in network” hospital, for a heart condition. Although he was given the best of care at Northern Westchester Hospital, Kenney said their facility was not equipped to treat her husband’s life-threatening condition. Due to medical necessity, Kenney’s husband was transported by an ambulance to Westchester Medical Center (WMC). The ER physician and the WMC cardiologist on duty arranged the transfer to WMC via phone. Kenney said there was no mention in regard to concerns over insurance coverage, or that WMC was an “out of network” provider during the treatment or transfer. However, Kenney later received a $99,000 bill from WMC due to the fact that it is an “out of network” hospital.
“This has been an absolute nightmare for my family and situations like this aren’t isolated cases. This is something that is happening to more people than we know who do not complain or try to fight it because the liability might be smaller and it is either paid by the policy holder, or they are too intimidated by the insurance companies,” said Maureen Kenney. “Insurance Companies should helping our citizens in times of need, not bleeding them for every dollar in a tough economy.”
Chad Glaser’s son Ethan was born with a rare liver disease, Biliary Atresia, and Ethan required out of network healthcare services. In 2003, Chad had the honor of being the live liver donor for his son Ethan, known by his friends and family as “E”. The successful transplant was performed at Morgan Stanley Children’s Hospital of NY Presbyterian.
Chad immediately identified the many concerns with regard to lack of transparency within the health insurance industry, including coverage for out of network specialty care that appeared at first glance to be comprehensive but in fact did not adequately cover his son’s care. Thus, he has focused the past ten years on the self-education of learning to successfully navigate the healthcare industry.
“My goal is to help pass Senate Bill S.2551 to bring protections to “Out of Network” medical costs / rates defined when medical care is required “Out of Network” not by choice but by necessity due to “In Network” Inadequacy,” said Chad Glaser. “When services cannot be rendered “In Network”, this bill will help provide coverage at the In Network co–insurance rates and deductibles and consequently will close the loop hole of balance billing to the patient. Why should any patient have to be subject to larger financial exposure when it’s not by choice, but by medical necessity to go “Out of Network?”
“This bill is all about preserving patient access to quality out-of-network physician services. It is wrong for insurers to promise out-of-network coverage to New Yorkers who pay their hard-earned dollars for premiums, and not to deliver adequate benefits for such services when they are needed,” said Dr. Thomas Lee, board-certified neurosurgeon and immediate past president of Westchester County Medical Society.
“I would like to thank Senator Ball and Senator Hannon for their work on this extremely important legislation,” said Dr. Bennie Chiles III, president of the New York State Neurosurgical Society. “In effect, what we are seeing here in increased premiums, increased profits, for the insurance companies, with decreased benefits to the patients, decreased patient choice and decreasing patient access to care, and all these things need to be preserved.”
Senator Greg Ball has created a petition on his website that has over 6,000 signatures. Click here to sign the petition.
For more information, please contact firstname.lastname@example.org or (518) 455 2200 in Senator Hannon’s Office or email@example.com or (845) 531-9796 in Senator Ball’s Office