A Bill that Takes Some of the Surprise out of Medical Bills

Every year, thousands of New Yorkers find themselves responsible for a surprise medical bill from a doctor, like an anesthesiologist, who becomes involved in their care but, unbeknown to the patient, is not covered by their insurance. 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.

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New Standards Issued for Review of Health Insurance Plans

“The Obama administration issued stringent new standards on Friday for health insurance to address a flood of complaints from consumers who said that costs were too high and that the choice of doctors, hospitals and prescription drugs was too limited in many health plans offered this year under the Affordable Care Act. In deciding which products can be sold in the federal marketplace next year, officials said, they will scrutinize health plans more closely and rely less on evaluations by state insurance regulators and private groups that accredit health plans.”

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