Dive Brief:
- New York is the most recent state to enact a law against certain forms of balance billing by out-of-network providers, including those utilized in emergency medical care.
- There is no federal law on the issue, but about a quarter of U.S. states have addressed it in some form.
- New York's law has been singled out by consumer advocates as a strong model for other states because it appears to be the most comprehensive law of its type, according to Jack Hoadley of Georgetown University’s Health Policy Institute, co-author of a recent study of balance billing laws in seven states.
Dive Insight:
The legislation addressing surprise balance billing is fueled by the trends of price transparency, consumers bearing larger portions of their health expenses and narrow-network plans.
The New York law is designed to protect patients from having to pay more than their in-network rates for out-of-network care provided in an emergency or without explicit consent. Examples include out-of-network physicians practicing at in-network facilities, or referrals to out-of-network providers without the patient's written consent.
"A key element that is really new is that for anyone who gets a surprise out-of-network service or who doesn't get the right disclosure [beforehand] about it, there's a way for the consumer to step out of the middle of the transaction," Mark Scherzer, legislative counsel at New Yorkers for Accessible Health Coverage, told Kaiser Health News.
New York healthcare consumers who get surprise bills can now complete an "assignment of benefits" form that allows their provider to seek payment from their health plan. By sending that to their provider and plan, patients pass off responsibility for any costs above their normal in-network expenses.