New York Out of Network Surprise Hospital Bill Passes State Senate

June 2019 ~

A new legislation has been introduced, that is intended to protect New York residents from unexpected surprise bills from hospital emergency department visits would give insurers the ability to pay hospitals outside their networks what they consider reasonable for emergency care, rather than what the hospital charged.

Assembly Bill A264B/Senate Bill S3171A prohibits hospitals from charging commercially insured patients higher, out-of-network rates for emergency services or inpatient services received in the immediate aftermath of an emergency.

Under the state’s current safeguards, when taken to an emergency department at a hospital outside their network, the patient is protected from having to pay a bill for the care and services received. The patient’s insurers is responsible for covering the cost of care, regardless of the amount due. The new legislation, however, would allow insurers to initiate an independent dispute resolution process, which would require an arbitrator to decide whether the hospital’s charge or insurer’s payment is appropriate.

There has been opposition to the bill from the hospital industry, claiming the bill coerces hospitals into joining insurance networks, reducing their bargaining power.

After compromising and settling on several amendments, one of which would require health insurers to provide the hospital with at least 25% more than the amount the health plan paid in its most recent in-network contract before taking any bill to arbitration,  New York state lawmakers voted to pass the bill.

The bill will now move on to the Governor’s desk for review and signature.


Source(s): New York State Senate; Politico New York; Crain’s New York Business; Times Union;