Patient Trying to Avoid Surprise Medical Bill Leaves Clinic Without Treatment

A New York attorney who has represented plaintiffs in surprise medical bill lawsuits found himself refused medical care after he refused to sign what he perceived was a “blank check” to the clinic.

Chet Waldman is a partner at Wolf Popper who shared his experience with Gothamist, a website by New York Public Radio. He said he went to the ProHealth Ambulatory Surgery Center in New Hyde Park, N.Y. for an epidural shot to treat chronic pain. The facility’s staff said he had to sign a patient financial liability form prior to receiving his treatment.

Waldman said he refused to sign the form as it was presented to him because he said it appeared he would agree to pay any costs that weren’t covered by his insurance.

(Full disclosure: Waldman is a lawyer for Wolf Popper, the law firm sponsoring the Surprise Medical Bill investigation on Top Class Actions.)

As an attorney who is very familiar with New York’s surprise billing law, Waldman said that the form basically undermines the rights of patients who are protected from balance billing financial liability when they receive out-of-network care without knowing it.

Walter had confirmed his doctor at Pro-Health was in his insurance company’s network, but he could not receive a definitive answer from anyone about whether the anesthesiologist was in-network or not.

Waldman decided his best course of action was to add the word “reasonable” in front of phrases on the form that referred to costs that may be left for him to pay. Waldman told the Gothamist that ProHealth refused to accept the modified form, and told him he was welcome to receive his shot, but without anesthesia.

He left without his pain-relieving procedure. Waldman later found out the anesthesiologist was in-network even though his insurance company had originally told him after the aborted visit that the anesthesiologist was not in-network.

Struggling to Avoid a Surprise Medical Bill

Now that Waldman knows the entire crew involved in his pending procedure is in-network at Pro-Health, he said he still is not signing that form unless they agree to his own edited version.

According to the Community Service Society of New York, the state now has the strongest protection against unexpected medical bills. The Health Care for All New York (HCFANY) coalition joined the New York State Department of Financial Services to create a consumer protection law to help protect citizens from financially debilitating out-of-network unexpected medical bills. The Community Service Society says it is a founding member of the HCFANY coalition.

The law took effect on April 1, 2015. Since then, disputed medical bills have been subject to arbitration between the insurance company and unpaid health care provider. According to a November article by NPR, the end result most often is that doctors end up being paid about three times as much as they would have been paid if they had been in-network.

Loren Adler, author of an analysis of the law’s impact so far and associate director of the USC-Brookings Schaeffer Initiative for Health Policy, told NPR he still believes consumers lose because they end up paying higher premiums to balance the cost of out-of-network care.

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This article is not legal advice. It is presented 
for informational purposes only.