New York’s Patient Billing Battle: Why Hospitals Are In The Crossfire

Patient billing can be a complex issue, but it can become even more complicated when patients receive care from out-of-network providers at hospitals without realizing it. Patients can be left with large bills they didn’t expect when these situations occur, leading many to feel dissatisfied with care and concerned with how they can pay their bills in a timely manner – if at all. While out-of-network care is an issue between patients and their insurers, hospitals can also be affected through uncollected patient payments. Hospitals may soon be expected to provide cost estimations to patients at the point of service, as lawmakers establish legislation to prevent patients from being hit with unexpected bills.

A new bill in New York
This patient billing problem can be an issue throughout health care, but hospitals in New York state may soon be required to provide patients with information about whether their treating physicians are in their insurance networks. According to The Associated Press, New York Gov. Andrew Cuomo recently signed into law a patient protection measure that mandates hospitals communicate with patients about the network status of their providers, even if it is in an emergency situation, as well as how large their bills will be through a cost estimation. The AP reported the bill could clarify the patient billing process for patients and prevent hospitals from receiving low patient satisfaction scores due to insurers not accepting claims. In essence, the measure works to protect those patients who receive care from an out-of-network provider in an emergency, not those who seek out care from expensive physicians who are not included in their networks.

Ben Lawsky, superintendent for the state’s financial services department, told the AP that the department sees thousands of complaints from patients who weren’t aware they were being treated by out-of-network physicians or how much their care would cost them, and the new measure will mandate hospitals provide cost estimations to patients.

While the bill won’t take effect until April 1, 2015, hospitals in the state will need to improve how they inform patients about their future medical bills, such as through cost estimations. However, this law may indicate that the health care industry is heading toward cost estimations and price transparency.

Prevent unexpected bills with cost estimations
Cuomo’s bill was created to prevent patients from being hit with large medical bills by surprise. Some patients may ask about their attending physicians’ network status, but many don’t – especially if it’s an emergency. However, even when patients do remember, it can often be difficult for providers to provide information to patients about whether their insurance will cover parts of their care. In fact, many providers may not even know if they are in-network for certain types of coverage, according to Bloomberg.

One hospital spokeswoman told the news source it can be next to impossible for hospitals to have current information on which providers are covered under which insurance plans.

“Since hospitals deal with more than 1,300 insurers, all with their own policies, insurers are in the best position to provide the information on what a patients’ out of pocket cost will be,” Marie Watteau, spokeswoman for the American Hospital Association, told Bloomberg in an email.

However, it may no longer be in hospital’s hands whether they can provide cost estimations or not. While hospitals often aren’t the ones at fault for patients’ unexpected bills because providers are out of network, they are the ones who feel the effects when patients are unable to pay these bills in a timely manner. New York’s bill may be an indication of where the industry is headed, and what patients may even come to expect from hospitals.