BILL NUMBER: S2374

SPONSOR: PERSAUD
 
TITLE OF BILL:

An act to amend the public health law, in relation to out-of-network
treatment disclosure for certain surgical procedures

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of the bill is to amend the public health law, in relation
to out-of-network treatment disclosure for certain surgical procedures.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. Subdivision 5 of section 230-d of the public health law, as
added by chapter 365 of the laws of 2007, is amended to read as follows:
every licensee performing inpatient and/or outpatient surgical care and
that requires pre-approval of surgical procedures by the patient's
insurance provider shall provide notice to the patient if all or a
portion of treatment approved is authorized to be rendered by a provider
that is not an in-network provider. Such notification shall be provided
              

to the patient by telephone call, e-mail or text message at the time of
approval by the licensee and shall be confirmed by mail not more than
twenty-four hours after approval of the surgical procedure. If the
licensee fails to provide such notice to the patient at least forty-
eight hours prior to the procedure, the licensee shall cover the cost of
the procedure as though the services were rendered by an in-network
provider. The provisions of this subdivision shall not apply to any
surgical procedure performed within twenty-four hours after the insured
sustains the injury necessitating the surgical procedure.

 
JUSTIFICATION:

In 2017, Peterson-KFF Health System Tracker found out "the rate of out-
of network charges for services at in-network inpatient facilities
ranged from 2% of in-network inpatient stays in South Dakota, Nebraska,
and Minnesota, to about a quarter or more in New York (33%), New Jersey
(29%), Texas (27%), and Florida (24%)".  Surprise billing has been an
issue and continues to be now that insurance becomes proesessively
complicated. For the most part, patients do not focus on whether their
surgical team is in-network; instead, they focus on the outcome as well
as making sure their surgeons are in-network providers. Members of the
underserved communities are the ones facing tremendous financial hard-
ship due to surprise medical bills. When patients are not able to pay
these outlandish surprise medical bills, providers and hospitals add
extra fees before reporting them to the credit bureau.  The harassment
patients face from credit companies is both unpleasant and stressful.

According to Fusion Anesthesia Solution: "10% of claims filed by physi-
cian anesthesiologists fall into the surprise-billing category".  It is
crucial to address these cases because not all surgical members that
performed these surgeries were in-network providers, and these patients
were not aware of it until they received the surprise bills.

One in five insurers is likely to receive surprise medical bills after
their scheduled surgery with in-network providers and hospitals. For
instance, a patient who went to a hospital covered by his or her plan
may receive a surprise medical bill from a provider who was not in-net-
work. Anesthesia and pathology claims are likely to have a surprise bill
from an in-network hospital visit, which includes care provided by an
out-of-network provider. According to an analysis that was done by
Peterson-KFF Health System Tracker:" for people in large employer plans,
18% of all emergency visits and 16% of in-network hospital stays had at
least one out-of-network charge associated with the care in 2017".

Anesthesiology is often within the category of services where surprise
billing occurs. Post-treatment patients are more likely to receive
surprise bills for reasons such as a visit to a specialist or provider
office that is not in-network. When a patient goes to an in-network
hospital, some of its staff do not have a contract with that patient's
insurance.

Patients should not be forced to make decisions about whether they
should pay their staggering surprise medical bills instead of providing
for their families, pay their mortgage, or rent. When dealing with
financial strains, receiving surprised medical bills may exacerbate
matters.

This legislation aims to protect New York State residents from receiving
unexpected medical bills from out-of-network providers by mandating
hospitals and providers to notify patients with at least twenty hours'
notice before their scheduled procedure.

 
PRIOR LEGISLATIVE HISTORY:

2021/2022: S108 Referred to Rules

2021/2022: S108 Referred to Rules

2020: S.19069 Referred to Rules

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law.