Health insurers have argued that they need to be able to make out-of-network charges and other cost-sharing arrangements stick to encourage enrollees to shop for care.
The New York State Department of Financial Services wants health insurers to pay any extra bills when their out-of-date provider directories send patients to out-of-network doctors and hospitals.
The state has proposed regulations that would require health plans in the state to make up the difference when a patient sees an out-of-network provider because of the use of:
- a stale online directory
- stale information from a customer service call center
- a paper directory that included provider network status information that was wrong on the day the paper directory was published
For health insurance professionals in New York, the proposed regulation could create opportunities to help some clients who are facing unexpected medical bills.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
