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HANYS Offers Concerns and Solutions at State Balance Billing Hearing

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In testimony delivered yesterday at a state hearing, HANYS recommended that all stakeholders come together to find a reasonable way to insulate consumers from surprise and balance bills for medically necessary, covered services. HANYS testified that efforts to protect consumers must address the root causes of the balance billing problem to avoid exacerbating problems accessing specialty care.

Consumers are sometimes surprised by unexpected medical bills for services delivered by providers who are not part of the patient’s health insurance network. The State Insurance Department and Department of Health called the hearing to learn more about this and related problems.

HANYS’ testimony, delivered by Jeffrey Gold, Vice President of Managed Care and Special Counsel, covered the following points:

  • Insured patients should not be surprised by unexpected bills for medically necessary, covered services
  • The managed care industry’s methodology to calculate as well as the adequacy of “usual, customary, and reasonable” fees are part of the root cause of the balance billing problem and must be addressed.
  • Prohibiting balance billing by non-participating physicians and/or establishing a default rate will not solve the underlying problems and could make matters worse.
  • Insurers are best positioned to inform consumers about possible bills before treatment is provided.
  • A form of arbitration that insulates the consumer from disputes over reimbursement may be the best resolution, but a comprehensive solution for consumers will require all stakeholders to come together.

Contact: Jeffrey Gold

Published October 8, 2008