To all ISASS New York Colleagues,
Legislation is pending in NY that will require out-of-network reimbursement rates to be tied to properly established UCR rate calculations (as opposed to inadequate bench-marking information). The New York State Society of Orthopaedic Surgeons (NYSSOS), together with the Medical Society of the State of New York (MSSNY), is seeking advocacy input from all NY-based spine surgeons and related health care professionals, scientists and researchers.
First and foremost, NY-based spine surgeons and their respective professional associations are urging support of bill S. 5068-B and A. 7489-B, now being considered in the NY Assembly and Senate. This bill “prohibits approval of a health maintenance plan that does not include coverage of out-of-plan medical services; requires every health maintenance organization contract to describe the methodology for reimbursement for out-of-plan medical services and the anticipated out-of-pocket expenses therefor to the enrollee.” In essence, this bill would have the dual effect of both establishing UCR rates as the “crosswalk” benchmark for out-of-network healthcare services and requiring the URC information established by the independent not-for-profit organization (established by former Attorney General Andrew Cuomo in his settlements regarding Ingenix data) to be the benchmarking authority.
Please follow this link to be connected to MSSNY’s Grassroots Action Center so you can contact your legislators in support of this important legislation:
NYSSOS and MSSNY are working with numerous in-state surgical practices and organizations to generate grassroots action on this legislation, and to demonstrate support for legislators sympathetic to the concerns of NY-based spine surgeons and their patients. NY spine surgeons must stand up to protect their profession and their patients. Please take a moment to learn more about this legislation, and how it will impact your practice and your patients’ access to surgical spine care.
The NY legislative session is scheduled to conclude business on June 21st so please act now to support this important initiative.