Health Insurance Coverage Loopholes

Hi Will,

There is an article in today’s NY Times about people going to emergency rooms for treatment and then facing large bills because the treating physician was not a network member even though the hospital was listed in the provider network. Eastern Massachusetts scored dismally on this survey with over 40% of all patients getting stuck with surprise bills. I think it is grossly unfair to expect a person in an emergency situation to have to price shop for treatment. Is this being discussed in the legislature? Link to the article is provided below.

I appreciate all you do,

Note: This post was originally posted on November 18, but did not appear until today due to a technical problem.

2 replies on “Health Insurance Coverage Loopholes”

  1. This sounds like a totally legit issue and I see from the graphic in the article that the researchers found it to be a problem in Massachusetts.

    We’ll look into it and see what we can learn about possible remedies.

    1. The Health Policy Commission (HPC) and the Joint Committee on Health Care Finance are aware of the issue and are trying to determine the appropriate scope of regulation for out-of-network billing.

      The HPC authored a 2015 policy brief on the state of out-of-network billing in the Commonwealth, policy solutions at work in other states, and a recommendation for legislative action.

      Additionally, the Special Commission to Review Variation in Prices among Providers discussed the need for action at a recent meeting.

      Andrew Bettinelli
      Legislative Aide
      Office of State Senator William N. Brownsberger

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