New York state doctors and hospitals serving patients enrolled in most health plans other than health maintenance organization plans can bill patients for amounts not paid by the plans.
The New York State Insurance Department Office of General Counsel presents that conclusion in OGC Op. No. 09-10-07, an opinion issued April 13 and posted to the Web earlier this week.
Officials in the office consider several questions about “balance billing” — the practice of health care providers billing patients for amounts not covered by health insurance.
One question concerns in-network providers treating patients with HMO coverage.
The other questions concern providers treating patients with coverage provided by an insurer that is not an HMO; patients with coverage from a self-funded employer plan; patients with coverage from a self-funded employer plan that offers an insured limited-benefit plan; or patients with high-deductible coverage.