OMBUDSMAN ALERT: NEW YORK STATE MUST ABOLISH ALL “SURPRISE” MEDICAL BILLS

By Dr. Louis Alpert

Following the September 29 Ombudsman Alert “Just Say ‘No’ to Surprise Medical Bills,” this writer contacted several state legislators, three of whom have pledged to consider sponsoring legislation in the upcoming year to amend the existing “Emergency Services and and Surprise Bills” law passed in 2014 and first implemented in April 2015.

This need for an amendment was first noted in the September 29 Ombudsman Alert. We reported that a number of Rocklanders, unaware of the existing law, had either paid a higher medical bill than they should have, or were unable to properly apply the law, which would have enabled them to appeal the higher charges in the “surprise” bill. The surprise bill typically included out-of-network charges for which the customer was responsible!

Unfortunately, when a patient is in a hospital , especially in its Emergency Room, he or she may not be in a position to demand that treatment be rendered by a doctor or other medical professional practicing within their network. In this context, as your Ombudsman, I suggested that all of our local state legislators consider an amendment to the existing law that would state in non-legal terms that any patient in a hospital setting and/or in an Emergency Room who is insured in a network different from the network doctors or providers who render them medical services, will NOT receive a “surprise” medical bill from any of the out-of-network providers. This clearly should have been the intent of the original “surprise” medical Bills law.

The appropriate bill(s) from the patient’s in-network provider should be the only bill(s) generated. Fortunately, three of our local legislators, Asseblywoman Jaffee, Asseblyman Zebrowski and Assemblyman Abinanti (Tarrytown) agree with the spirit , if not the actual language of tthe proposed amendment.

This article ends with some comments made to me from each of these state legislators:

Assemblyman Zebrowski: Chris Bresnan, chief of staff, in his office stated, “We will take a look at the law and review ways to strengthen and improve it. We will be thoroughly looking at the law and speaking with our health and insurance committee staff to see what can be done to improve the law. The Assemblyman is always looking at ways to provide patients with more transparency concerning their medical bills and hopefully can build on the success of the 2014 law.”

Assemblyman Abinanti: Spokesman J. Sold of the office, said, “Assemblyman Abinanti is supportive of an amendment to the Surprise Medical Bill legislation that will help to ensure that it protects consumers, as intended, including not receiving bills for out-of-network services rendered in a hospital emergency room. Assemblyman Abinanti will support appropriate legislation to address the problems that exist as he believes strongly in the purpose of this bill.”

Assemblymember Ellen Jaffee said, “We should certainly consider adding an amendment to the current law that will go a step further to protect vulnerable patients who receive life-saving hospital or emergency services from an out-of network provider, by ensuring that the only bill generated for these services will come from the patient’s in-network provider.”