Dive Brief:
- A New York state law that took effect March 31 now requires insurers and healthcare providers to warn patients in advance about out-of-network charges that typically increase medical bills 20% or more. Now, patients will only pay these increased out-of-network bills if they knowingly pursue the treatment anyway.
- The legislation came as a result of at least 10,000 complaints by New York residents who said they were billed by out-of-network specialists used without their knowledge.
- Health plans in the state must also now meet new standards for their provider networks, in accordance with an independent review board. When a provider network is deemed insufficient, insurance companies and healthcare organizations will be asked to negotiate a deal to cover the patient's out-of-network costs.
Dive Insight:
While many consider the law a victory for healthcare consumers, critics say it falls short by failing to address certain concerns about health plans purchased on the state's public exchange, the New York State of Health. Many exchange plans offer narrow networks that increase the likelihood of out-of-network charges.
According to the Journal News, there was a push last year to require these plans to include out-of-network coverage, but it failed as a result of opposition by insurance companies and other businesses concerned that it would increase the up-front cost of coverage.
Experts expect to see further debate over the issue later this year as the next enrollment process gets underway.