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New health care measure in New York
Old 04-01-2014, 03:31 PM   #1
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New health care measure in New York

The NY Times reports NY State has announced a measure to require hospitals to give advance notification to patients if an out-of-network doctor will be treating them. Otherwise the patient is only responsible for the equivalent copay of an in-network doctor. http://www.nytimes.com/2014/03/31/ny...tml?ref=health

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Now a provision in the state budget agreement announced Saturday is intended to protect consumers by requiring that they be given a reasonable amount of notice when an out-of-network doctor will be treating them.

If they are stuck with a surprise bill, patients will be responsible only for whatever their co-pay would be if the doctor were in-network. The out-of-network doctor and the insurance company will have to hash out the bill using what is known as baseball arbitration, with each proposing a price and an arbitrator choosing one of them. The law will go into effect in one year.
It doesn't completely eliminate this practice, which is a burden on patients, but it looks like a good first step. Patients receiving scheduled treatment provide the hospital with all the information it needs to ensure the care is covered by the insurer.
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Old 04-01-2014, 03:36 PM   #2
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This is something that is a real minefield -- when you look at an insurer's list of "in network" facilities and you may see the hospital and even the doctor listed, but they may refer you to someone outside the network or may perform procedures with imaging centers, anesthesiologists and others who may be out of network.
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Old 04-02-2014, 06:34 AM   #3
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That is a pretty simple step that can help quite a bit -- albeit only in NY. If Congress would just work together on the ACA all sorts of tweaks could be enacted that would make the system better nationally.
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Old 04-02-2014, 08:32 AM   #4
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From a consumer's standpoint this seems like a pretty good idea.
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Old 04-02-2014, 10:52 AM   #5
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I am a simpleton in this area not ever having to deal with a hospital bill yet. But as I age I do worry about the issue, since my policy is a fairly tight in network one. I think once you enter the hospital and they know your in network provider it should be their responsibility to organize it correctly. And if they cannot, they should tell you before hand so you can make plans accordingly. It doesn't seem right to have to talk to everyone who appears to be involved in prepping you for surgery to have to ask them if they are in your network. It should be like my house I had built for me. I agreed with the contractor on the price, and whoever he hired and paid to assist him to build it was his problem not mine.


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Old 04-02-2014, 01:14 PM   #6
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This is a fantastic idea. When my wife was having her initial cancer treatments we were bombarded with doctors, radiologists, oncologists, on and on. Through the fog of the shock of the diagnosis and emergency surgeries very few have the wits to say, wait a minute, is this guy/gal/facility/service provider in my network?
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Old 04-02-2014, 01:34 PM   #7
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I whole-heartily agree. Who is in a position to select their anesthesiologist? If the hospital selects the anesthesiologist and the hospital is in network there is no justification for an out of network anesthesiologist attending a patient. Likewise if the surgeon selects the anesthesiologist.

Oh, and then there are the 'ghost' professionals who just appear at the table or bedside that may file a claim for services provided that the patient has no control over. I remember that happening when my parents were ill.
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Old 04-02-2014, 06:03 PM   #8
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Sounds like a great first step, I've been hit by this issue. Emergency appy, out of network surgeon. Cost a extra grand or so( in1998 $). Big wakeup call to me.

My former manager had a major surgery(14 hours), received a six figure bill from one of the specialists involed. He did dispute and win as the out of network specialist was the only one in this area. Took the guy months to get it made right.

Last thing a preson wants, trying to get well, finding out how provders and insurance works.
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Old 04-02-2014, 06:29 PM   #9
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Quote:
Originally Posted by Mulligan View Post
I am a simpleton in this area not ever having to deal with a hospital bill yet.
Wow, congrats on that.

I had to deal with this issue 5 years ago @ age 49 when I was hospitalized for a few days after an accident. Some of the treatment I received was from out-of-network physicians and I was stuck with a few bills. Fortunately, the bills didn't amount to an awful lot -- not compared to the (ginormous) overall bill, which for the most part was covered by my insurance. Still, it grated on me that I was billed for out-of-network services in which I had no say over whatsoever.

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Originally Posted by Mulligan View Post
I think once you enter the hospital and they know your in network provider it should be their responsibility to organize it correctly.
One would think. But, that ain't the way it's done. I doubt there was any attempt whatsoever to determine if the providers were in my network.

The NY measure posted by the OP is very long overdue, here's hoping other states follow suit.
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