NY Proposes New Rule On Out-of-network Health Care

NEW YORK (AP) — State insurance regulators have issued a new regulation aimed at preventing New Yorkers from being blindsided by high bills when they see an out-of-network doctor.

The regulation will force insurance companies to help customers better calculate the true cost of getting care outside their networks.

Typically, insurers tell patients they will pay 70 to 80 percent of the "usual and customary" charges for whatever treatment they receive. The patient is responsible for the rest.

In many cases, however, that language can be misleading.

For years, critics have complained that the database most U.S. insurers use to calculate that "customary" rate is defective and routinely underestimates the real costs of care.

Patients sometimes decide to go outside their network, expecting to pick up, at most, 30 percent of the tab, only to find out after the fact that their insurance company will only reimburse them for a small part of the bill.

The system is already on its way out in New York.