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August 07, 2020 10:45 AM

N.Y.: Insurers shouldn't charge patients for healthcare providers' PPE

Crain's New York Business
Shuan Sim
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    New York's Department of Financial Services on Wednesday issued guidance to health insurers to ensure that patients are not charged for the personal protective equipment used by health care providers.

    Insurers also had to instruct healthcare providers to refund PPE fees charged to patients and to inform their insured members that they cannot be charged those fees during visits.

    The guidance came in light of consumer complaints sent to DFS, particularly regarding dental providers. The fees go beyond a patient's applicable cost-sharing, and those increased costs must be resolved between the health insurer and provider rather than passed on to the patient, DFS said.

    "In these uncertain times, as many New Yorkers are struggling to make ends meet, healthcare providers should not be creating additional financial burdens on their patients," Gov. Andrew Cuomo said in a release.

    Various local media had reported on dental practices charging additional fees of $10 to $20 to cover the cost of face masks and shields.

    A spokeswoman for the New York State Dental Association responded that the DFS guidance is not directed at healthcare providers but to insurers, telling them to honor their contracts with patients and participating providers. Therefore, it affects only those insurers who may have been telling their participating dentists that they are allowed to charge a separate PPE fee, she said.

    She added that the American Dental Association strongly encourages dental offices to disclose any additional fees upfront to patients and to document these charges in the patient record.

    The ADA had recommended in April that providers use the "unspecified preventive procedure" code to document the cost of PPE and urged health insurers either to increase the maximum allowable fee per procedure or allow a standard fee per date of service. The ADA stated it believed it was inappropriate to place the cost burden on dentists by disallowing or bundling charges.

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