New York Out-of-Network Protections Arrive

[AllenChicago]

March 30, 2015

"Health maintenance organizations, or HMOs, already must authorize out-of-network coverage for emergency services, with patients required to pay only their usual network deductibles, copayments and coinsurance.

That requirement will now extend to other insurers as well. They will pay what they deem reasonable to doctors, who can take disagreements to independent dispute resolution.

Leslie Moran, spokeswoman for the New York Health Plan Association, emphasized that many new provisions will apply to health insurance policies bought or renewed, that for many consumers they will be effective next Jan. 1. Insurers' contracts and policies have to be rewritten, which is taking place. They're trying to make sure everyone has the same rules and understands them, she said."

Article: ALBANY, N.Y.: NY starts out-of-network health coverage protections | Business | Bradenton Herald

 

[MariannaWeiner1]

Effective for services received on or after March 31, 2015, EmblemHealth has set up new protections to ensure that — in the following circumstances — members of EmblemHealth insured plans won't be responsible for costs other than the in-network cost-sharing (in-network copay, coinsurance and/or deductible) that applies under your plan.