A handful of urgent care centers in New York will have to find ways to make their fee structure and status with various health plans clearer to prospective patients as part of a settlement with the state attorney general’s office. The four operators, all in the New York City metropolitan area, have agreed to do the following:
- Identify all health plans with which it has contracted to be an in-network, participating provider on its website. If the center does not participate with all products within a health plan, it has to specify the insurance products for which it is an in-network, participating provider
- Post and provide the information in writing to the patient at the time of registration
- Stop using the terms “works with” or “accepts” in relation to a healthcare plan, in favor of “in-network participating provider” or “out-of-network.” The centers must also explain that “out-of-network” services will cost the patient more than in-network services
- Ensure the patient does not incur out-of-network costs if the required information is not communicated to the patient
- Require all healthcare providers billing at the center to be an in-network participating provider with all healthcare plans with which the center contracts as an in-network participating provider.
- Disclose the availability of fee information to patients, and, upon request, disclose the total cost for services that the center will bill the patient
The agreement comes at the end of a months-long investigation, during which 20 urgent care centers received letters asking for information about the declarations on their websites concerning their participation in certain health plan networks. The attorney general expressed concern that the disclosures did not make it clear to patients if they were seeing an “in-network participating provider” or whether services would be considered “out-of-network,” possibly leading to patients receiving higher-than-expected bills for out-of-network treatment.
The attorney general also issued a consumer brochure about urgent care centers (available at: http://www.ag.ny.gov/sites/default/files/pdfs/bureaus/health_care/new/Urgent_Care_Centers_brochure.pdf).