The New York State Department of Financial Services has issued a proposed regulation that aims to protect consumers who are provided misinformation about whether healthcare providers are part of their insurance network. The proposed regulation is an attempt, being promoted by consumer advocacy groups, to reduce what are known as surprise medical bills, which occur when an individual is billed for healthcare treatment that are not part of their health insurance network.
About 20% of individuals who visit emergency rooms are likely to receive surprise medical bills, because they are either sometimes treated by doctors who are not part of the hospital’s insurance network or because the patient was taken to a facility that is not part of his or her health plan. Surprise billing is important to the accounts receivable management industry because one-in-10 surprise medical bills are for at least $400, a financial threshold that many consumers find too much to be able to afford, according to studies and reports.
The proposed regulation would define provider directory misinformation when:
- A provider who does not participate in the insurer’s network is incorrectly listed as an in-network provider in the insurer’s online or hard copy provider directory;
- In response to a consumer’s request for information by telephone, an insurer indicates in writing that a provider is in-network when the provider is not in-network; or
- An insurer fails to provide network status information in writing to a consumer within one business day of the consumer’s request for such information by telephone.
“Consumers should not be surprised by large out-of-network costs when they receive healthcare services from providers they believe are in-network based on incorrect information provided by their insurer,” said Adrienne Harris, the DFS’s Acting Superintendent, in a statement. “This proposed regulation ensures New Yorkers have accurate and up-to-date information about which healthcare providers are in-network so that they can make healthcare decisions with more transparency. This proposal will help consumers protect their financial health and well-being.”