On Wednesday, March 7, 2012, the New York Department of Financial Services released a report entitled “An Unwelcome Surprise: How New Yorkers Are Getting Stuck with Unexpected Medical Bills from Out-of-Network Providers.” The report found an overwhelming need for increased transparency from insurers and healthcare providers, as well as improved consumer protection measures to ensure New Yorkers stop receiving unexpected medical bills from out-of-network providers. The report proposes a number of reforms, such as: (i) increased disclosure by insurers of their methodology for determining out-of-network reimbursements; (ii) increased disclosures from insurers and medical providers regarding anticipated out-of-network costs associated with the provision of non-emergency care; (iii) a prohibition on excessive fees charged in emergency care situations; (iv) improving network adequacy protections for PPO and EPO subscribers (such as those enjoyed by HMO subscribers); and (v) minimum standards for out-of-network coverage.
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