A recent lawsuit filed against the Hochul administration accuses the New York government of slashing access to specialty doctors and potentially life-saving medical treatment for 1.2 million government workers and retirees.
Filed in the Albany Supreme Court, the plaintiffs have accused 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, who oversee the health insurance program, 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.
Joseph, one of the plaintiffs also 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.
“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 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 says doctors can no longer file a payment dispute complaint or an appeal with state regulators.
“If these actions do not immediately cease, 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 suit said.
The slash 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 suit alleges.