Empire State regulators say they are getting many complaints from consumers who have picked in-network doctors and in-network hospitals but end up with out-of-network bills from anesthesiologists and other providers.
The New York State Insurance Department and the New York Health Department plan to hold a hearing on the topic Oct. 7 in Albany, N.Y., department officials say.
The hearing will cover issues such as disclosure of network status, referrals to providers who turn out to be out-of-network providers, and use of emergency services from providers who turn out to be out-of-network providers.
The hearing also will cover the challenges of patients who seek care from in-network hospitals but end up receiving some of their care from doctors and other providers who are not in-network, without being given the choice of using in-network providers.
“Consumers are put in an impossible position,” New York Insurance Superintendent Eric Dinallo says in a statement about the issue. “They follow the rules of their health insurers and receive care from a participating doctor and hospital, believing that all related services — such as laboratory, anesthesiology and pathology — will be covered at the in-network rate. Despite their best efforts to stay in-network, consumers are often shocked to get a big bill because the anesthesiologist or pathologist is not in their health plan’s network.”