“New York Gov. Kathy Hochul’s administration is being accused in a lawsuit of secretly slashing access to specialty doctors — and potentially life-saving medical treatment — for 1.2 million government workers and retirees,” the New York Post reports.
The explosive claims, laid out in a suit filed in Albany Supreme Court, accuse Hochul officials of illegally ignoring state law when making changes to the Empire Health Plan, which serves state and local government employees.
The suit says Acting Commissioner Rebecca Corso and the state Department of Civil Service have dramatically slashed the reimbursement rates that “out of network” doctors can receive for providing services to plan members.
“Some of my members, their families and millions of Empire Plan enrollees may be prevented from seeing physicians that they have treated with for years,” said Bridge and Tunnel Officers’ Benevolent Association president Wayne Joseph in an affidavit filed in the case.
— New York Post (@nypost) October 31, 2022
A lawsuit alleges that New York Gov. Kathy Hochul's administration secretly slashed access to specialty doctors as well as potentially life-saving medical care for 1.2 million government workers and retirees. https://t.co/7bL2YBwCZ1
— Newsmax (@newsmax) October 31, 2022
Cont. from the New York Post:
Joseph, one of the plaintiffs — along with another Empire Health Plan beneficiary and 18 out-of-network doctors and medical practices — charged that the allegedly illegal “unilateral action” and “life-changing event” was “never communicated” to the 1.2 million enrollees.
The suit accuses Hochul officials of relying on a federal law, over state legislation, in order to set lower reimbursement rates for out-of-network doctors.
But state officials counter that they’re complying with the law and are imposing cost controls to protect taxpayers and plan premiums and to prevent doctors from gouging the program.
The explosive claims come as Hochul is locked in a tight election battle with Republican rival Rep. Lee Zeldin.
The incumbent Democrat in June announced a five-year labor deal with the Civil Service Employees Association of New York representing more than 52,000 state workers that includes raises of 2% each for the first two years and 3% each for the remaining three years — plus a one-time lump bonus of $3,000 — in exchange for the union agreeing to encourage in-network employee utilization to help control health insurance costs.
“The Empire Plan unilaterally determined itself no longer subject to New York insurance law or Department of Financial Services’ regulation. Consequently, the Empire Plan considers itself no longer obligated to reimburse out-of-network physicians at the long-standing UCR [usual, customary and reasonable] rates used in New York,” the suit initially filed by plaintiffs’ lawyer Roy Breitenbach of Harris Beach said.
“As a result, starting in 2022, Empire Plan unilaterally cut reimbursement to out-of-network physicians by more than 80%,” it states.
The suit claims that doctors can no longer file a complaint about a payment dispute or an appeal with state regulators.
“If these actions do not immediately cease,” the suit adds, “thousands of high-quality, well-respected out of network physician practices that provide medically necessary surgical and specialty medical services to Plan enrollees will go out of business or drastically curtail their services.
“The current accessibility of quality medical care available to Empire Plan’s 1.2 million enrollees will be severely impacted, and irreparably so for those patients that require such care now.”
The suit goes on to add the cut in payments will impact emergency care at hospitals and “will cause Plan enrollees, and patients in this state as a whole, to lose access to life-saving emergency treatment.”
The surprising change to the government health workers has left patients recently informed of it terrified about losing access to life-saving care.
“This will have a huge impact on me,” Empire Health Plan member Kathleen Makridakis, 56, of Rockville Centre, said. “I had spinal cord surgery twice.”
“They were only doctors out of network who could do the surgery,” she added. “If I have to worry about these doctors getting paid, that screws me up. I can’t afford owing a doctor a $100,000.”
Despite some who are concerned the resulting changes to their healthcare plan could leave them out to dry, state officials argue that their actions are legal and reasonable.
Daniel Yanulavich, who works for the Department of Civil Services’ Employee Benefits Division, says that the Empire Plan provides adequate patient protection and claims the real conflict is over out-of-network doctors wanting more money.
Yanulavich says out-of-network providers were getting an average of 540% of what Medicare pays doctors, and anesthesiologists were charging 3,000% more than what Medicare pays. He goes on to argue that it was time for the state to rein in the costs.