By Joshua Lerner, LCSW
New legislation has been introduced by Assemblyman Gary Schaer which would affect out of network mental health professionals. Among other provisions, this bill would require that out of network professionals make "good faith and timely efforts" to collect his or her patient's co-insurance, co-payment or deductible. It would also amend existing benefit assignment legislation by excluding providers from receiving direct payment if the practitioner violated the obligation of collecting patients' payments. Under the bill, any practitioner that either directly or indirectly acts to or offers to waive, rebate, give, or pay an insured person’s obligation (sic., read “deductible/copay”) under the terms of an insurance policy can be fined up to $10,000.00, serve up to 18 months imprisonment or both.” It as well proposes that out-of network practitioners be paid the same as in network providers. The intrusiveness and restraint of trade in this proposal is overwhelming.
This bill sets out draconian punishments for waiving co-pays, co-insurance etc. It is clearly putting forth actions which are a restraint of trade. Attempts to control out of network reimbursement forces everyone into becoming a member of networks and criminalizes a therapists responding to the financial needs of their patients. I urge everyone to contact their representative to fight against this bill.
Outlined below is the proposed legislation.
- 1. (New section) a. A health care provider delivering health care services under a managed care plan or a self-funded health benefits plan shall make a good faith and timely effort to collect each covered person’s liability, including any deductible, copayment, or coinsurance, owed by a covered person to the provider pursuant to the terms of the covered person’s health benefits plan. For the purposes of this section, a health care provider shall be deemed to have made a good faith and timely effort to collect the covered person’s liability if the health care provider makes three good faith and timely attempts to collect.
- b. A health care provider shall retain all records relating to any attempt to collect a covered person’s liability pursuant to subsection a. of this section for at least seven years following the date on which the record is made. All such records shall be open to inspection, upon request, by the Department of Banking and Insurance.
- c. Notwithstanding subsection a. of this section, a health care provider may waive a covered person’s liability to the provider if: (1) the health care provider determines that the covered person has a medical or financial hardship; and (2) such waivers are not granted by the health care provider routinely or excessively. The health care provider shall notify the carrier or the entity providing a self-funded health benefits plan whenever the health care provider waives a covered person’s liability pursuant to this subsection.