A Conversation on the Status of Surprise Bill Laws and Future Challenges

On October 29, CSS Vice President of Health Initiatives Elisabeth Benjamin joined a panel hosted by The New York State Health Foundation to discuss the state of surprise bill legislation alongside Troy Oechsner, Deputy Superintendent of Health at NYS Department of Financial Services, and Loren Adler, Associate Director of USC-Brookings Schaeffer Initiative for Healthy Policy.

You can watch the full discussion here.

In 2014, Benjamin helped craft the nation’s first law to protect patients from surprise medical bills through a partnership between the NYS Department of Financial Services and Health Care for All New York (HCFANY), of which CSS is a founding member. Previously, consumers who utilized in-network medical care could receive monumental bills if, without warning, an out-of-network provider participated in their care.

The new law, which was enacted in 2015:

1. Holds consumers harmless from out-of-network emergency bills and non-emergency claims where an in-network provider isn’t available or proper disclosures about network status are not made. Consumers will only have to pay in-network cost-sharing in these situations.

2. Insures that consumers will no longer be left to negotiate surprise bills on their own. Instead, bill negotiation will be left to providers and plans through an independent third party.

3. Improves disclosure by insurance plans and providers, so that consumers can make informed decisions when purchasing a plan and scheduling services.

4. Holds more plans to network adequacy standards and review.

5. Makes the claim submission process more consumer friendly.

 

These protections have saved thousands of consumers from unfair bills when no appropriate provider is available in-network.

In this conversation with The New York State Health Foundation, the three panelists discuss why this law has been so important for consumers, how to protect consumers even further, and what challenges lie ahead.

Learn more about CSS’ role in successfully implementing the surprise bill law. If you think you have received a surprise medical bill, you can contact Community Health Advocates (CHA) for assistance.

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