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Bill Would Change Out-of-Network Health Coverage

MOUNT KISCO, N.Y.-- When her husband was transported from Northern Westchester Hospital to Westchester Medical Center for a medically necessary heart procedure in April of 2011, Maureen Kenney never expected she would be stuck with the entire bill.

Since her husband was stable at the time of the move, which was necessary since the procedure could not be performed at  Northern Westchester Hospital, Excellus BlueCross BlueShield said it did not consider the transfer an emergency service. This allowed the company to leave the Bedford Hills resident to pay $99,000 since Westchester Medical Center was an out of network hospital on their policy. Kenney still has $56,000 left to pay.

A press conference was held Thursday at Northern Westchester Hospital to call for action by the governor and legislature to pass a bill that would force insurance companies to fully disclose their methodology for reimbursing health care treatment by physicians not participating in the plan's network.

This is the second time since January State Sen. Greg Ball (R-C, Patterson), who put forth the legislation has come together with Kenney to push for change on this issue. He said insurance companies are raking in billions of dollars while taking advantage of working families.

At the event, Dr. Bennie W. Chiles III, president-elect of the New York State Neurological Society, cited this bill as the most important piece of health care legislation currently being debated in the state.

“In effect, what we are seeing here is increased premiums, increased  profits for the insurance companies with decreased benefits to patients, decreased patient choice and decreasing patient access to care, and all these things need to be preserved,” Chilles said. Another physician present to support the bill was Dr. Thomas Lee, a neurosurgeon who is president-elect of the Westchester County Medical Society.

In addition to forcing insurance companies to reveal their out-of-network care reimbursement policies, the bill also proposes prohibiting approval of health plans that do not include coverage of out-of-plan medical services.

It also would require insurance companies to disclose the anticipated out-of-pocket costs for specific out-of-network health care services.

Kenney said she has been through hundreds of hours of dealing with BlueCross BlueShield, and has filed two grievances, both of which have been rejected. She is now in the throes of what will likely be a lengthy appeal process.

“This bill needs to be passed not only because it will save New Yorkers money,” Kenney said, “but it will save us from having to suffer through hours of frustration and stress over unpaid medical bills that we expected and trusted our insurance providers to pay.”

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