In 2015, New York State enacted the first-in-the-nation consumer protection act against surprise bills for emergency medical services. Prior to this, insured patients were getting surprise bills because someone who treated them was out of network (unbeknownst to the patient), with providers charging patients the difference between very high hospital charge rates and the plan’s out-of-network coverage. Under New York’s law, in qualifying situations, payment disputes between providers and health plans over the fees for out-of-network services are now mediated through an independent review process, so the consumer isn’t left bearing the costs. The law also requires new disclosures to patients regarding costs or network status, as well as hospital audits by the New York State Department of Health to ensure compliance.

Other states have since sought to address surprise bills. Researchers have identified the need for a federal-level intervention, and recently a bipartisan workgroup in the U.S. Senate released draft legislation. But improvements are still needed under the current system of protections, including costs related to the outsourcing of firms for the emergency room and ambulance transport. In New York State, there have been advocacy efforts to enhance current consumer protections and ensure that consumers are fully insulated from any liability that the law was intended to prevent.

On October 29, 2018, NYHealth hosted a conversation with experts to discuss the state of this landmark law and how it is benefiting consumers, the remaining gaps in the system, and future challenges. Panelists were:

  • Troy Oechsner, Deputy Superintendent of Health, New York State Department of Financial Services
  • Elisabeth Benjamin, Vice President of Health Initiatives, Community Service Society of New York
  • Loren Adler, Associate Director, USC-Brookings Schaeffer Initiative for Health Policy
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