Surprise-billing complaints decline under New York law, study finds

A New York state law to protect patients form surprise out-of-network bills has resulted in a significant decline in consumer complaints about the issue, according to a new case study by researchers at Georgetown University.

State lawmakers passed the Emergency Services and Balance Billing Law in March 2014, and the law took effect a year later. The law is designed to protect patients from massive bills after emergency situations or other situations in which the patient may not have enough time to check whether the provider is in-network or out-of-network.

The state's law and its binding arbitration process to settle payment disputes between providers and insurers has captured the attention of federal lawmakers crafting surprise-billing legislation.

Since March 2015,  there has been a "dramatic" decline in consumer complaints about balance billing, according to the study. Balance billing occurs when a patient receives services from an out-of-network provider and is billed for the difference between what the patient's insurer pays and what the provider determines the care is worth.

The law has "downgraded the issue from one of the biggest [consumer concerns our call center receives] to barely an issue," one regulator told researchers.

Researchers said insurance company representatives also reported a drop, but the representatives could not quantify it.

While the law has been a success as far as consumer complaints declining, the researchers said the law still contains gaps regarding surprise balance bills that occur when patients are misinformed about whether the provider is in-network or out-of-network and when patients go to out-of-network facilities in an emergency.

The researchers said that the state must also wait for federal action to fully protect patients enrolled in self-funded employer plans.

 

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