To: Nily Rozic (NY-25), Toby Ann Stavisky (NY-16), The New York State House, The New York State Senate, and Governor Andrew Cuomo
Mandate Out-of-Network Benefits on NYS Insurance Exchange
All Insurers selling policies on the NYS Insurance Exchange should be required to offer plans (at every "metal" level) which include Out-of-Network (OON) benefits (at 80% UCR based on Fair Health Database) with a cap on out-of-pocket OON expenses.
They should also be mandated to cover nationally recognized Centers of Excellence and health care providers caring for patients at these centers on an in-network basis, at least in the cases of life-threatening conditions/procedures like cancer, transplants, etc. This should be true even if these centers are out of the plan's usual geographic region, including out of state.
They should also be mandated to cover nationally recognized Centers of Excellence and health care providers caring for patients at these centers on an in-network basis, at least in the cases of life-threatening conditions/procedures like cancer, transplants, etc. This should be true even if these centers are out of the plan's usual geographic region, including out of state.
Why is this important?
I have a family member facing life threatening cancer. Because she is a Federal employee, she was able to see the best surgeons and oncologists at the best cancer centers around the country. At some of the facilities where she received care, entire departments (radiology) were out-of-network. All of her care has been out-of-state, and it has been covered, with both in- and out-of-network caps on out-of-pocket expenses.
Since I purchase my coverage on the NYS Insurance Exchange, I would not have access to the life-saving treatment she was able to obtain were I to God forbid need it.
Plans currently sold on the NYS Insurance Exchange do not provide financial protection against unaffordable medical expenses. They cover in-network coverage for a limited region only. Often in-network hospitals have individual practitioners, services, or entire departments that are out-of-network with a plan. None of these bills, including doctors and hospitals out out-of-state, would be covered by existing plans offered on the NYS Exchange.
Furthermore, when faced with a life-threatening condition (cancer, transplants, etc.), we who purchase insurance on the NYS Exchange should be able to have access to nationally recognized Centers for Excellence on an in-network basis. We shouldn't have to choose between saving our lives and bankruptcy.
Those purchasing insurance on the NYS Insurance Exchange should have access to the same coverage as Federal Employees with nationwide plans in this regard.
Since I purchase my coverage on the NYS Insurance Exchange, I would not have access to the life-saving treatment she was able to obtain were I to God forbid need it.
Plans currently sold on the NYS Insurance Exchange do not provide financial protection against unaffordable medical expenses. They cover in-network coverage for a limited region only. Often in-network hospitals have individual practitioners, services, or entire departments that are out-of-network with a plan. None of these bills, including doctors and hospitals out out-of-state, would be covered by existing plans offered on the NYS Exchange.
Furthermore, when faced with a life-threatening condition (cancer, transplants, etc.), we who purchase insurance on the NYS Exchange should be able to have access to nationally recognized Centers for Excellence on an in-network basis. We shouldn't have to choose between saving our lives and bankruptcy.
Those purchasing insurance on the NYS Insurance Exchange should have access to the same coverage as Federal Employees with nationwide plans in this regard.