Brewster, N.Y. – (5/11/12) – On January 27, 2012, Senator Greg Ball (R, C – Patterson), along with Bedford Hills resident, Maureen Kenney and local physicians held a press conference to bring awareness to the Out-of-Network issue, as well as push for the passage of Senator Ball’s legislation (S5068/A5068A).
Senator Ball’s legislation would force insurance companies to do the following:
- Fully disclose their methodology for reimbursing health care treatment by physicians not participating in the plan’s network;
- Prohibit approval of a health maintenance plan that does not include coverage of out-of-plan medical services;
- Disapprove issuance of a health insurance policy offering coverage for out of network care that will not provide significant coverage of the usual costs of receiving care out of the plan’s network;
- Require health insurance companies to disclose to their enrollees, upon request, the anticipated out-of-pocket costs for specific out-of-network health care services.
The issue of Out-of-Network care in New York State has been picked up by the New York State Department of Financial Services Superintendent Benjamin Lawsky, who held his own press conference regarding Out-of-Network care on March, 7 2012.
“Since January, there has been a great deal of dialogue on this issue.” said Senator Ball. “We’ve seen different versions of a solution on this issue, and it is critical all parties come to an agreement before the end of the legislative session. You have multi-billion dollar insurance companies that are seeing record profits, you have a healthcare system that is broken, you have blue-collar families that are being held over the barrel by insurance companies that are raking in billion-dollar profits and doctors that are being forced out of this state in droves and it’s actually reaching a critical level, we cannot wait another year.”
The Out-of-Network issue was brought to Senator Ball by Kenney, who after purchasing a premium insurance plan, was stiffed with the bill in her families time of need.
In April of 2011, Kenney’s husband was treated in the ER 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 transfer to WMC was arranged by the ER physician and the WMC cardiologist on duty 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.
“I think it’s 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,” says Kenney. “Our citizens should not be intimidated by insurance companies, who should be helping our citizens in times of need, not bleeding them for every dollar in a tough economy.
“Anyone could find themselves in the same situation Maureen Kenney is now facing,” Senator Ball said. “I am urging everyone to tell their local elected officials to help us pass this critical piece of legislation and give New Yorkers the quality, affordable healthcare they deserve.”
Who: Senator Greg Ball
Bedford Hills resident, Maureen Kenney
Local Physician Dr. Thomas Lee
Local Physician Dr. Michael Brisman
What: Press conference calling for action by the Governor and Legislature on the Out-of-Network issue.
When: Thursday, May 17th 2012, 2:00 PM
Where: Northern Westchester Hospital, 400 East Main Street, Mount Kisco, NY 10549
For more information or to speak with Senator Ball, please contact Krista Gobins: (845) 200-9716.