Requires hospitals to inform emergency care patients whether the attending physician participates in the insured's insurance policy

1 Co-sponsor

• Phil Boyle

BILL NUMBER:S1197

Title of bill

An act to amend the public health law and the insurance law, in relation to requiring hospitals to inform emergency care patients whether the attending physician participates with the patient's insurance policy and requiring insurance companies to cover the cost of out-of-network care for patients who are unconscious or otherwise unable to provide informed consent

Purpose

The bill requires hospitals to inform patients if they are to be treated by an out-of network doctor. The bill also provides that in certain circumstances if emergency services provided by an out-of network provider the cost sharing requirements will be the same if the services were provided by an in-network provider.

Summary of provisions

Section 1. The bill requires that every general hospital which patients receive emergency care must adopt regulations requiring its staff to inform patients whether the attending physician participates with the patient's insurance policy. The patient can then decide if they want to be treated by the out-of network physician or request treatment by an in-network physician.

Section 2. Requires that every policy that provides coverage for services to treat an emergency condition in a hospital facility that meets the specified criteria and services are provided by a non-participating provider, the cost-sharing requirement shall be the same requirement that would apply if the services were provided by a participating provider.

Justification

In 2011, Nathan Roethstein was bite by a dog and sought medical treatment at a provider hospital. Due to the severity of the bite his parents were told that he would have to be seen by a plastic surgeon. The Roethsteins were not aware that the plastic surgeon on-call at the time was not an in-network provider. The Roethstein were made aware of this when Nathan went to the surgeon to get his stitches out and his parents were presented with a large medical bill, which their insurance would only cover a small portion off. The Roethsteins are not the only family in New York whom after receiving emergency care received a large medical bill because the attending physician that they saw was out-of network. This bill attempts to solve this problem. By requiring hospitals to inform patients if the physician on-call is in their network will provide patients with the choice to see the physician or to request an in-network physician. This will help patients to make an informed choice to hopefully decrease the number of New Yorkers who struggle to pay high medical bills. The bill will also alleviate this financial burden by requiring that in certain emergency situations the cost-sharing requirement for services provided by a non-participating provider be the same

requirement that would apply if the services were provided by a participating provider.

New York's families are already struggling in this hard economic time. Many cannot afford the huge medical bills that are associated with being treated by an out of network doctor in an emergency situation. This bill takes the necessary steps to try and cut down on cost of emergency care.

Legislative history

2011-12 - S.6189 - Referred to Health

Fiscal implications

Needs to be determined.

Effective date

This law shall take effect on the one hundred twentieth day after it shall become law.