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Ball Backs Bill for Health Insurance Financial Reform

Legislation would force disclosure of reimbursement formula, ban denial of coverage for out of network healthcare providers.

Citing a large cost that his constituents recently got from their insurer, state Sen. Greg Ball came to on Friday to outline a bill that would limit such practices.

At the Mount Kisco press conference, Ball was joined by Bedford Hills resident Maureen Kenney and her husband, who suffered a rapid heart beat that was initially looked at in Northern Westchester Hospital and then referred to Westchester Medical Center in Valhalla. Maureen Kenney, who is the policy holder, would up getting a bill for $99,000. She thought that her insurance company, which she declined to disclose because of ongoing negotiations over the price, would cover 80 percent for the out-of-network care. Instead, she said, its policy is to provide 80 percent of a cost that they feel is appropriate for the medical service, which means for less financial support. This is different from what doctors would describe as the reimbursement they need.

“You know, It wasn’t elective surgery," her husband said. "We didn’t get botox injections here.”

Kenney called Ball's proposal an "excellent example of legislation that needs to be passed to protect hard working New Yorkers from ever having to experience the situation like this.”

Dr. Thomas Lee, a neurosurgeon at Northern Westchester Hospital, talked about how doctors are not given an adequate reimbursement rate by insurance companies. He said that people are paying for insurance believing they are getting a better policy, which is not true.

“These are simply illusory benefits that’s promised by certain health plans," he said.

Ball's legislation, which is still in the state senate's insurance committee, has several measures. They include forcing insurance companies to disclosure their reimbursement formulas for out-of-network healthcare providers, ban insurance plans that do not provide out-of-network coverage, and disclose upon request the costs to be paid out of pocket by enrollees when they are treated out of network. The bill also prohibits policies for non-network providers that do not provide enough coverage for the usual cost of the services.

ChrisChin April 27, 2012 at 08:48 AM
I think what would make the insurance industry seem like less of a villain is more transparency. There are many insurance companies who are shrouded with an air of secrecy, about how they pay out and why they increase their rates. This new law would be a great step in forcing the company to pay out fairly, and to provide the coverage that we expected. Chris - http://americanvisitorinsurance.com

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