Hochul sided with hospital lobby over insurers and wage dispute

Governor Hochul is following the example of his predecessor, Andrew Cuomo, by siding with the powerful hospital lobby in the fight against insurance companies and unions over medical bills.

Opponents, including United Federation of Teachers union president Mike Mulgrew, said the “pay and go” proposal backed by Hochul in her $227 billion spending plan would require health insurance companies to pay hospital bills immediately without checking to see if there was treatment. medically necessary.

Opponents argue that the plan could lead to increased costs and losses, and that it is difficult to recover a payout after bills have been paid if the procedure is deemed unnecessary.

“This proposal does not take into account the people who pay the cost – and that’s us. These are my members,” Mulgrew told The Post.

“Additional costs are passed on to us. It’s stupid and it has to stop.”

A group called the Patient Defense Coalition, which includes members of the health insurance industry and labor unions, is running a television ad criticizing the plan and urging people to call Hochul’s office to stop him.

The six-figure ad purchase is heavily funded by the New York Association of Public Health Plans and Blue Cross/Blue Shield.

But there are other powerful unions in the coalition, including the International Service Workers Union’s Local 32 BJ, the Teamsters, the New York State Business Council and the National Federation of Independent Business.

“The profits of hospitals will increase, as will the cost of your medical care. Tell Governor Hohul that ‘pay and go’ is not for you,” reads the ad, which came into the hands of The Post and contains the phone number of Hole’s office.

The billing law change is included in the Hohul spending plan; the final budget, to be agreed with the legislature, is due April 1.

“The Pay and Follow proposal, which requires hospitals to pay before providing information to determine if a service is clinically acceptable, and then forces health plans to go through a lengthy and cumbersome process to obtain reimbursement, will increase costs for consumers. , employers and taxpayers,” said Eric Linzer, president of the NY Health Plan Association.

“Furthermore, this proposal will make it difficult to ensure the safety and efficiency of patient care and will provide nothing but unexpected financial income for hospitals.”

The legislature rejected Cuomo’s hospital payment plan when it first proposed it in 2021. Houkul revived him.

“The Payments and Solutions Act, included in the FY24 Executive Budget, will greatly improve administrative efficiency without any significant differences in claim payment,” said Court Ruddy, a spokesman for the State Department of Health.

He said the legislation would require insurance plans to pay claims to hospitals for emergency admissions within a reasonable time after services have been rendered. The insurers then have the right to challenge claims paid to the hospital that they believe were inappropriate because they were not medically necessary.

Ruddy said unions and self-insurance plans are not included in the Pay and Resolve bill. Industry sources claimed that union workers’ medical bills were being covered.

The hospital industry applauded Hochul for siding with her and dismissed the fears of insurers and labor unions as overblown.

“New York City hospitals strongly support this sound position and thank Governor Hochul for including it in his budget. There should be nothing wrong with paying hospitals on time for the emergency services they have already provided, especially when these giant commercial insurance companies are sitting on billions in profits,” said Brian Conway, spokesman for the Greater New York Hospital Association.

“And don’t be fooled by the publicity for this misguided coalition. Health insurers will still be able to contest the medical necessity of any procedure and reimburse costs if it is determined that the challenge is justified. This budget proposal does not change the outcome of good-faith disputes about the need for medical care – it simply guarantees that hospitals will be paid for services already provided in a timely manner. Both the state Medicaid program and the federal Medicare program pay first and then conduct due diligence checks – why not insurance companies?