New York Launches Overhaul Of Insurer Payment Dispute Resolution Process
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Politico Pro (8/13, Cordero) reported the New York Department of Financial Services has begun an “overhaul” of the state’s healthcare “payment dispute resolution process, a proposal that fueled a contentious fight between insurers” and physician organizations. The state budget included major changes “to reshape the obscure process used to settle health care payment disputes. The changes included excluding payment disputes involving Medicaid Managed Care plans, creating a new benchmark-based arbitration system for state employee health plans and barring certain claims from arbitration when a prior-authorization determination had identified the disputed service as out-of-network.” The article noted, “The Medical Society of the State of New York, which represents doctors, is in the process of drafting legislation to introduce next year that would reverse the changes.” MSSNY Executive Vice President Dr. Thomas Lee told Politico Pro in an interview, “I think we really ought to focus on patient-facing activities, and not value administrators or middlemen over the people that provide the actual care.” Politico Pro noted, “Lee said he is not giving up without a fight. He said he remains hopeful that the Legislature may reverse the changes next year, given that the issue was a sticking point in budget negotiations with both the Senate and Assembly opposing the proposal. In the end, Hochul managed to negotiate a deal on the matter in the final days of budget negotiations, but at the time many lawmakers lamented the inclusion of the overhaul.” Dr. Lee concluded, “We’re going to see a cascade of [physicians] not willing to take a call because you can’t get paid at all in the emergency setting, or in the hospital setting. We’re already seeing some of our physicians out there saying I can’t afford to do it anymore, so we’ll start to see more as the regulation and implementation goes forward.”
