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March 08, 2012 at 08:33 AM
The New York Department of Financial Services is blasting the gaps in coverage and health plan provider network contracts that can leave patients who try to see in-network doctors on the hook for thousands of dollars, or tens of thousands of dollars, in unexpected out-of-pocket expenses.
The department is investigating the unexpected out-of-network claim problem in response to what officials say is “an overwhelming amount of consumer complaints.”
The department released a preliminary out-of-network claims report that gives some of the worst examples investigators heard about.
One involved a child who had heart surgery at an in-network hospital, and the surgeon was an in-network surgeon.
“The child’s parents were not told an assistant surgeon would be involved in the procedure and that assistant surgeon was out-of-network,” officials say. “The family was forced to pay $5,000 of that doctor’s $6,400 bill.”
Many other cases involved bills for emergency services, radiology or anesthesiology. One patient cited received an unexpected $1,300 bill from an anesthesiologist who turned out to be an out-of-network provider, officials say.
The investigators that the average emergency out-of-network bill was for $7,006 and was for 14 times the amount Medicare would pay for the services.
The average out-of-network radiology bill was 33 times what Medicare pays, officials say.
