Health care Rx: Lower costs - Rochester Democrat and Chronicle

Concerns related to affordable health care are being discussed by many families and small business owners across upstate New York. The topic is also being debated in Albany.

One idea, which appears to run counter to controlling costs, would establish minimum payments for doctors who do not participate in a health plan's network. When a provider is "in network" they agree to receive "payment in full" from the health plan (other than routine cost sharing); when a provider is not in a plan's network, they are free to charge a consumer any amount they desire. This results in consumers paying more for coverage, and oftentimes not knowing the amount until care has already been provided.

In Rochester, virtually all physicians participate in our local network. Problems associated with this issue most typically stem from cases of:

• non-routine service, such as plastic surgery, where in-network patient choices are limited;

• lack of disclosure, such as when an anesthesiologist assisting a surgeon practices outside the network.

In these cases, costs by the plastic surgeon or the anesthesiologist are a wild card, and can result in extraordinarily high, unanticipated bills that are not covered by health insurance.

Several downstate legislators have advanced a measure (Senate Bill 5068/Assembly Bill 7489B) that, unfortunately, is poorly constructed and will benefit such specialty doctors. It fails to address a condition that plagues small businesses: providing employees with affordable comprehensive health care benefits that ensure quality coverage and prevent sticker-shock if treatment is provided by an out-of network doctor.

The bill would not protect consumers from unexpected and excessive medical bills from out-of-network providers. In fact, it may drive additional doctors from networks because their out-of-network fees could be more lucrative than mandated minimums.

Government mandates decrease choices and drive up business costs. By mandating reimbursement rates for doctors' self-set fees, health insurers will have no choice but to increase the cost of premiums. As the cost of premiums rise, fewer businesses and individuals will be able to afford health insurance.

When it comes to solving New York's health care challenges, the mission is clear: rein in costs, maintain access to coverage and enhance patient protections by increasing transparency.

We urge the members of the Legislature to reject this bill and focus their energy on measures that will help make health insurance more affordable, accessible and transparent for individuals, families and businesses.

20 May, 2012