New York's health insurance industry will work with health care providers to ensure PPE fees are refunded to patients
Gov. Andrew Cuomo on Wednesday announced the New York State Department of Financial Services has issued new guidance to New York health insurers to ensure patients are not charged personal protective equipment fees by health care providers that participate in their insurer's network.
"In these uncertain times, as many New Yorkers are struggling to make ends meet, health care providers should not be creating additional financial burdens on their patients," Cuomo said. "This action will ensure that New Yorkers are protected against excessive fees associated with the necessary and at times live-saving care they need."
DFS has received consumer complaints that participating health care providers, particularly dental providers, are improperly charging their patients fees for PPE or other charges related to increased costs due to COVID-19, which fees are being passed to their insurers and go beyond the insured patient's applicable cost-sharing.
The governor’s office said, “A participating provider should not charge a patient fees or other charges in addition to the patient's financial responsibility for covered services and insurers should not cover these charges. In addition, DFS does not approve policy or contract provisions that hold the insured patient responsible for the cost of a participating provider's PPE.”
Superintendent of Financial Services Linda A. Lacewell said, "DFS' circular letter reminds insurers in New York state that they should ensure that consumers are not charged PPE fees. Consumers are not liable for fees that go beyond their financial responsibility in the insurance policies or contracts. It is essential that health care providers and insurers collaborate so that consumers receive the care they need during this uncertain time, without extra fees."
New York State Health Commissioner Dr. Howard Zucker said, "Health care providers should not be charging patients for PPE under any circumstances. Providers have an obligation to ensure the safety of their patients and employees during all medical visits, from routine check-ups to surgical procedures."
DFS' circular letter advises insurers to:
√ Immediately notify their participating providers not to charge PPE fees and that insureds should be held harmless for these charges;
√ Instruct providers to refund PPE fees to insureds;
√ Notify insureds that they should not be charged for PPE fees and provide insureds with insurers' contact information to submit related complaints;
√ Work with their providers to resolve issues relating to increased costs due to COVID-19, including PPE fees, so insureds are held harmless for these fees, which may require that insurers request information from providers about whether insureds were charged improper fees; and
√ Work with their providers to ensure that refunds are provided to insureds; and
Within 90 days of the circular letter, report to DFS the amount of PPE fees charged to insureds, the number of insureds impacted, and a description of how refunds will be provided.
New Yorkers with complaints about an insurance policy should contact DFS at www.dfs.ny.gov/complaint or through the DFS consumer hotline at 212-480-6400 or 518-474-6600 8:30 a.m. to 4:30 p.m. weekdays.