Advocates are cheering a new state law {that} will help New Yorkers avoid surprise bills and unexpected expenses for medical procedures.

The Emergency Services and Surprise Bills law, which goes into effect March 31, expands transparency and protects consumers who receive care from out-of-network physicians while at a participating hospital or ambulatory surgery center; as well as for emergency services. It also contains protections for those who must go out of network for a specialist or procedure not available within their insurer’s network.

The law will be a life-saver for people who need to go out-of-network for care, said Chad Glaser, a sales manager at Schneider’s Premium Seafood who has spent more than 10 years fighting for changes that would allow his son to receive services he required for a liver transplant outside Western New York.

Eleven years after his transplant, Glaser’s son, Ethan, now 13, is doing fine, but still requires follow-up care outside the region. With the law kicking in, Glaser will no longer need to fight for permission every six months for that to happen.

“This law opens up transparency to reimbursements,” he said. “You need to know what your financial responsibility is going to be so you can make sound financial decisions.”

Five years ago, Glaser joined the consumer advisory board of FAIR Health, a national, independent, nonprofit that works to bring transparency to health-care costs and insurance information. The organization was founded in late 2009 as part of the settlement of an investigation by New York state into health insurance industry reimbursement practices which had been based on data compiled and controlled by a major insurer.

Robin Gelburd, president of FAIR Health, said there are hundreds of “Chad’s” out there who struggle to do the right thing and be responsible, only to be stuck later when the bill arrives.
She points to a classic example: A pregnant woman specifically picks a hospital that’s part of her insurer’s network, then ends up needing an epidural that’s performed by an anesthesiologist who’s out-of-network but working at the hospital.

“She’s not in the position to begin asking,” Gelburd said. “Likewise, with emergency care that needs to be done, the consumers are not in a position to start questioning and evaluating plan participation.”

Hospitals and physicians will face new requirements to comply with the law, including posting prices online for procedures and alerting patients if they will receive care from an out-of-network physician or location; while insurers must update medical directories promptly to reflect who is in and out-of-network. Insurers must also use better reimbursement comparisons so consumers can select which plan is the best value for their needs.

The state Department of Financial Services details http://dfs.ny.gov/consumer/hprotection.htm the benefits for both consumers as well as the requirements for providers. The law also creates a dispute resolution process to ensure that providers are paid fairly for their services.

The Medical Society of the State of New York helped craft the law along with the insurers around the state.

“All stakeholders came around the table to work through these rather thorny issues to come up with fair, workable, equitable solutions that could meet the needs of all constituents in the healthcare sector,” Gelburd said.

-Tracey Drury-Buffalo Business First

This article was originally published here:
http://www.bizjournals.com/buffalo/news/2015/03/23/nys-law-in-effect-april-1-eliminates-surprise.html?s=image_gallery