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NY lawmakers request data to prevent insurance overpayments




Lawyers estimate New York State could pay more than $1 billion for health care amid a growing disparity in hospital costs depending on where a person receives treatment.

Some lawmakers are working to find out by how much.

“There is a lot of data to show that, overall, hospitals are charging very fluctuating costs, and with patient fees or charges and under different insurance schemes for some really basic care” , said Sen. Andrew Gounardes, a Democrat. from Brooklyn.

Gounardes and State Assembly Catalina Cruz, a Democrat from Queens, sent a letter to the commissioners of the state civil service and state health departments requesting data to assess the cost of 1 .2 million state workers enrolled in New York State’s health insurance program and how much the state is overpaying its beneficiaries.

Hospital costs fluctuate widely, with health care costs rising more than 200% since June 2000, according to the American Enterprise Institute.

For example, an MRI for someone without insurance costs less than $500 at Mt. Sinai Health System in New York City, compared to more than $7,400 for a patient with health benefits at New York Presbyterian across the street. street.

In the letter, lawmakers asked the Public Service Department for a list of questions to determine which hospital systems were overcharging for standard procedures.

They want to know how much public money is being spent on the state’s health insurance plan and hospital care for employees to ensure the state – the biggest purchaser of health care in New York – manages taxpayer funds properly.

“It will help us understand how much of a problem it really is,” Gounardes said.

Lawmakers have chosen to evaluate the state health insurance program, or the data over which they have control, to take a step toward fairness in hospital affordability. But it is an issue that affects all workers when negotiating their benefits.

“What they learned in the [budget] hearings last year, the state doesn’t even track that information,” said Manny Pastreich, SEIU 32BJ union secretary-treasurer.

Several unions and healthcare providers have come together to form the Coalition for Affordable Hospitals.

A person with health insurance can pay up to three or four times what hospitals charge the government for Medicare, Pastreich said.

“We think the state is probably overpaying for health care by a billion dollars or more,” he said. “What could the state do with a billion dollars for other priorities than simply paying more than necessary for high-cost hospitals? »

Lawmakers did not give the Civil Service Department a timeframe to receive the data, but expect it could take several weeks as the state compiles the information during the open registration period.

“We are reviewing the letter. As health care costs continue to rise nationwide, the Department of Public Service remains committed to working with state employee unions and our 1.2 million NYSHIP participants to provide comprehensive and affordable health coverage while protecting New York State taxpayers,” according to a statement from the Public Service Department when asked about the letter and cost of the state health plan.

The State Health Department regulates hospitals in the state and cannot oversee the state health plan and has referred all matters to the Civil Service Department. The department will respond to the legislators’ offices about the letter to direct them to the other agency.