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.”
Officials cite a case involving a woman who had a surgical procedure at an in-network hospital but received a $1,500 bill from the anesthesiologist.
The anesthesiologist “balanced billed” the consumer for the difference between her plan’s out-of-network rate of $1,000 and the billed rate.
“The consumer was ultimately put into collections by the anesthesiologist for the difference between the amount her health plan paid and the amount the anesthesiologist charged,” officials say.
“The Insurance Department and Department of Health are considering statutory and regulatory changes to address these issues and would like to receive input from consumers, health plans, providers and other interested parties,” officials say.”