Out-of-network coverage uncommon in New York marketplace plans

Most New Yorkers are not able to find out-of-network coverage in health plans offered on their state exchange, according to a Kaiser Health News report.

With the exception of a few insurers in far western New York and around Albany, the only options available in other areas of the state, including the New York City metro area, are HMO-style plans that cover care provided only by physicians and hospitals in the plan's network, according to the report. People with those plans generally must pick up the tab for their entire bill if they go out of network for anything other than emergency care, the report reads.

In the report, experts cite a number of contributing factors to the situation in New York, such as "a difficult history in the individual insurance market."

Insurers on the individual market were previously required by law to cover anyone who wanted a plan, regardless of their health, according to the report. Peter Newell, director of the health insurance project at the United Hospital Fund of New York, a research and philanthropic organization, told Kaiser Health News the state later required that two standardized HMO plans be offered in the individual market, only one of which offered out-of-network benefits. According to the report, insurers had a hard time maintaining a customer base that wasn't too expensive to cover because of this, so, Mr. Newell told Kaiser Health News, "insurers are a little gun shy" after that.


More articles on payer issues:

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Fitch publishes special report on national health insurers


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