USA TODAY WHITE PLAINS, N.Y. — Dana Roberts
was raising two children in Yonkers and suddenly found herself wasting hours on
the phone fighting insurers and medical offices over a $1,500 bill.
She had to track down her medical
records, talk to a lawyer and research similar cases. At one point, Roberts
said she started recording conversations about settling the unexpected charge.
Her distrust seemed appropriate.
Roberts, 33, said she was unconscious when the $1,500 was tacked onto her
surgery cost.
"Nobody said the
anesthesiologist was outside of my insurance network," she said.
Thousands of similar complaints
by New Yorkers — many involving bills from specialists used unbeknownst to
patients — prompted a state law seeking to protect against surprise medical charges.
State regulators reported receiving at least 10,000 complaints about the
problem.
The law, which took effect March
31, requires insurers and health care providers to give patients more
information on out-of-network insurance charges that typically increase bills
at least 20 percent.
Those higher charges apply when a
patient is treated by a doctor or other provider outside their insurance plan's
network. Under the new law, patients will only pay higher out-of-network bills
if they choose to pursue the treatment after receiving sufficient warning.
Insurance plans are also being
required to meet new standards for improving provider networks, as determined
by an independent review board. When a network falls short, insurance companies
and health care providers negotiate a deal and cover the out-of-network charge.
The law is considered a victory
among patient advocate groups, but some of its protections don't address
concerns about insurance plans sold on the Affordable Care Act exchange,
called the New York State of Health.
A push to require plans sold on
the government-run insurance marketplace to include out-of-network coverage
failed last year. Many insurance companies and other business groups opposed
the effort, saying it would have increased the up-front cost for coverage.
More than 2 million New Yorkers
enrolled for 2015 in Affordable Care Act plans, many of which offer
increasingly narrow provider networks that limit choice, and thus expose
patients to out-of-network charges.
"New York State of Health
should offer affordable out-of-network coverage options, which are particularly
important for patients with complex health care needs," Chuck Bell,
program director of Consumers Union, said.
Debate over amending regulations
and laws affecting plans sold on New York State of Health will ramp up again in
the summer and fall, when the enrollment process begins anew for 2016.
For Roberts, the current surprise
medical bill law came too late. Her kidney stone surgery was in 2012, about
three months after her son's birth. The collection agent called months later in
2013, seeking payment of the $1,500 anesthesiologist bill.
The debt collection shocked
Roberts, who thought the bill had been settled in 2012 between her insurer,
EmblemHealth, the Westchester Anesthesiologist group, in Rye Brook, and
Lawrence Hospital Center, in Bronxville. She said she ended up paying $500
after reaching an agreement that reduced the bill.
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