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Albany passes patient protection legislation

New York Teacher

In a big victory for the UFT, union-supported legislation curbing exorbitant hospital fees charged to out-of-network patients for emergency care passed both houses of the state Legislature in June. It now needs Gov. Andrew Cuomo’s signature to become law.

The bill, which passed the state Assembly on June 5 and the state Senate on June 19, subjects emergency room charges by out-of-network hospitals to the same independent arbitration process that has curtailed out-of-network emergency room doctor’s bills in New York since 2014.

“The coalition we are a part of said enough is enough — it’s time to level the playing field in health care for the benefit of patients and consumers and that is what this bill does,” said UFT President Michael Mulgrew.

The UFT came together this spring with a group of labor, consumer, health and business organizations to form the Patient Protection Coalition to advance the legislation and combat hospital price gouging. The coalition produced a hard-hitting television ad that ran in Albany, Westchester County and Long Island as well as on social media to pressure lawmakers to address the issue.

When city employees have gone to out-of-network hospitals in an emergency, their insurance companies have been stuck with whatever costs hospitals charged for emergency room care and any resulting hospital admissions. Patients eventually bear these costs, either in higher rates, reduced benefits or in some cases direct out-of-pocket expenses.

According to data gathered by the coalition, a broken leg treated during an emergency admission to an out-of-network hospital could cost $221,000, or 316 percent above market average charges, while a first- or second-degree burn treated in an out-of-network hospital emergency room could cost $184,000, or 491 percent above average market charges.

Under the new legislation, insurance companies can dispute those kinds of bills through an independent dispute resolution process. That process has reduced the cost of doctor’s bills for out-of-network emergency care by 34 percent, according to the coalition’s research.

The UFT lobbied hard for the bill on the belief that the legislation would rein in costs and remove the incentives for hospitals to stay out-of-network as a way to charge insurers higher rates.

“As we continue to confront our very difficult challenge of controlling our health care costs, this is a very important piece for us,” Mulgrew said.

Insurers will initially be required to pay hospitals at least 25 percent above the in-network rate for the out-of-network emergency care provided. However, both the hospital and the insurer may use the dispute resolution process to contest any part of this initial payment deemed unreasonable.