By LINDA A. LACEWELL

For many Americans, a trip to the hospital often brings an unwelcome aftershock in the mail: a bill for costs not covered by insurance, called a surprise medical bill. One in five Americans will receive a surprise medical bill from a doctor they didn’t know was outside of their health insurer’s network or for a procedure they did not — or could not — know wasn’t covered.

To pay for surprise medical bills, some Americans have been forced to take out loans; others have literally gone broke.

A study of more than 2,000 consumer complaints conducted by the New York State Department of Financial Services (DFS) in 2012 found that the average out-of-network emergency bill was $7,006, of which insurers paid an average of $3,228, leaving consumers, on average, to pay $3,778 for an emergency in which they had no choice. Meanwhile, according to the Kaiser Family Foundation, 18% of all emergency visits and 16% of in-network hospital stays had at least one associated out-of-network charge in 2017.

The system is in critical condition, and the federal government needs to step up to reform it — now.

But while more Americans are crushed by the weight of these bombshell bills, legislation to protect Americans from surprise medical bills is gridlocked in Washington.

Ten years ago, New York’s then-Attorney General Andrew Cuomo took action to protect New Yorkers from out-of-network and surprise medical bills. I am proud to have led that initiative by eliminating an insurance industry-owned database of out-of-network costs and creating an independent entity to help insurers ensure that out-of-network costs are accurate, current and transparent to consumers. Under Gov. Cuomo’s leadership, DFS worked with various stakeholders to pass and implement the first legislation in the nation providing comprehensive protection for consumers against surprise medical bills.

From its implementation in March of 2015 through the end of 2018, the Out of Network Law has saved New Yorkers more than $400 million in emergency services alone, reduced out-of-network billing in New York by 34%, and lowered in-network emergency physician payments by 9%.

This law protects consumers from out-of-network bills for emergency physician services in a hospital and surprise bills in hospitals and other outpatient settings. It includes extensive consumer protections, including holding consumers harmless for costs beyond in-network deductibles, copays or coinsurance, improved disclosure, enhanced network adequacy requirements, expanded appeal rights, and easier claims submission.

At the center of the law is a process called Independent Dispute Resolution (IDR), which removes consumers from billing disputes. Instead, providers and health plans settle billing, and use the IDR process for disputes.

We have made great progress in New York, but we recently learned about a Long Island man who was left owing $220,000 for back surgery after receiving $650,000 in bills his insurer did not fully cover. When the governor learned of the incident, he spoke to the man directly and DFS made it right. We fixed the problem immediately and now he doesn’t owe any more than his normal deductible.

To ensure that other cases don’t fall through the cracks, we must act to further protect New Yorkers in similar situations. DFS will issue regulatory guidance to ensure that insurance companies properly notify patients about how they can seek relief from surprise medical bills.

Any New Yorker who currently has an issue with surprise medical bills can file a complaint at www.dfs.ny.gov/complaint, call DFS’s hotline (800-342-3736), or reach out to DFS’s dedicated email: [email protected].

Tackling and solving the problem of surprise bills in a large, complex medical market like New York took leadership, compassion and courage, all of which are sorely lacking in Washington.

But if we got it done in New York, so can the rest of the nation. Already, other states are using New York’s Out of Network Law as a model, and the federal legislation now under consideration is based, at least in part, on our law.

With medical costs soaring and crushing debt from surprise medical bills further burdening consumers, Washington needs to follow New York’s lead and act quickly before this healthcare headache gets even worse.

Lacewell is the superintendent of the New York State Department of Financial Services.

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