Hochul Sides With Hospital Lobby Over Insurers, Labor In Pay Dispute

 

Ho-Chol has followed in the footsteps of his predecessor, Andrew Cuomo, and has sided with the powerful hospital lobby in the fight against health insurers and unions over medical costs. Opponents, including National Teachers Union President Mike Mulgrew, said the "pay and trace" proposal Hochol endorsed in his $227 billion spending plan would allow health insurance without auditing whether treatment was medically necessary. He said he would require the company to pay the hospital bills immediately.

Opponents argue that the plan could increase costs and waste, and if the procedure is deemed unnecessary, it will be difficult to collect payments once the bills are paid.

“What this proposal does not take into account is the people who bear the costs: us. These are my members," Mulgrew told the Post. 

"Additional costs will be passed on to us. This is ridiculous and we need to stop this."

A group called the Protect Patient Coalition (which includes the health insurance industry and labor unions) has launched a TV commercial attacking the plan, urging people to call her Hochul's office and stop it. Six-figure ad purchases are funded primarily by the New York Public Health Planning Association and the Blue Cross/Blue Shield. But the federation also includes other influential unions - Local 32 BJ of the Services Employees International Union, Teamsters, New York State Business Council, National Federation of Independent Business and others.

“Hospital profits will increase, and so will healthcare costs. Tell Governor Ho-Chol that 'payment and tracking' isn't for you," read an ad obtained by the Post.

Billing law changes are included in Hochul's spending plan. The final budget to be negotiated with Congress is due April 1st.

"The 'Pay and Pursue' proposal requires payment from hospitals before submitting information to determine whether services are clinically appropriate, and then a lengthy and cumbersome process to force health insurance companies to do so. Reimbursements inflate costs for consumers, employers and taxpayers," said Eric Linzer, president of the NY Health Plan Association.

“Furthermore, the proposal will only make it more difficult to ensure safe and effective care for patients and provide a financial windfall for hospitals.” 

Lawmakers rejected Cuomo's hospital-friendly payment plan when it was first proposed in 2021. Hochul revived him.

"The Pay and Settlement bill included in the Fiscal Year 24 budget will significantly improve administrative efficiency without creating a large disparity in claim payments," said Cort, a spokesman for the state health department. Rudy said.

He said the law requires insurance plans to pay hospitals claims for emergency room visits within a reasonable time after services have been rendered. You have the right to appeal if you believe it is unreasonable because it was not medically necessary. Mr Ruddy said unions and self-insurance schemes are not included in the Pay and Resolve bill. Industry sources claimed union members' medical expenses were covered.

The hospital industry applauded Hochul for taking her side, dismissing her concerns expressed by insurance companies and unions as exaggerated.

“New York hospitals strongly support this smart move and thank Governor Ho-Chol for including it in their budget. It shouldn't be controversial, especially when these giant commercial insurance companies make billions of dollars in profits. "And don't be fooled by this misguided Coalition ad. This budget proposal does not change the outcome of disputes over bona fide medical needs, it merely ensures that hospitals are promptly paid for services already provided. Both state Medicaid and federal Medicare programs pay up front and track medical needs through post-mortem audits, so why not health insurance companies? 

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