The routine is familiar for most people: When checking in for an appointment with a doctor or other health care provider, patients typically complete and sign a pile of paperwork, including a form that contains some version of the statement, \u201cI agree to pay for all charges not covered by my insurance company.\u201d<\/p>\n
Patients may not feel comfortable making that financial promise, often before they have any idea what the charges will be. But they generally sign the form anyway, because the alternative is often not to get the services they\u2019re seeking.<\/p>\n
As a result, consumers may be responsible for unexpected bills and at risk for medical debt.<\/p>\n
In New York, state officials, advocates, and the health care provider community have been engaged in a policy tug-of-war over efforts to protect consumers. Their advocates don\u2019t want them to get stuck signing \u201cblank check\u201d forms that put them in financial jeopardy. Doctors, hospitals, and other providers don\u2019t want to disrupt their practices\u2019 workflow and payment logistics with cost discussions and paperwork, especially after services have been provided. State officials\u2019 efforts to find a satisfying compromise have so far fallen short.<\/p>\n
At the center is a state law<\/a> that took effect last fall to prohibit requiring patients to sign such consent-to-pay forms before they\u2019ve received treatment and discussed the costs.<\/p>\n Legal analysts described it as the first such law in the country. Physician groups cried foul, saying it would raise payment issues and other significant logistical problems.<\/p>\n Those concerns found traction. Shortly before the law\u2019s start date, the state\u2019s Department of Health delayed its implementation indefinitely. In addition, Democratic Gov. Kathy Hochul\u2019s proposed fiscal year 2026 budget would let providers go back to requiring patients to agree to pay for care in advance of receiving treatment. It also clarified that the consent requirements would not apply to emergency care.<\/p>\n A key provision of the new law would remain in place, however: Doctors and other providers would still be obligated to have the cost discussion with patients before the patient is asked to sign the form agreeing to pay for the service. Some consider this a significant step.<\/p>\n \u201cProviders having an affirmative obligation to discuss treatment costs is unique,\u201d said Gregory Mitchell, a partner in the health and life sciences practice group at McDermott Will & Emery law firm who specializes in managed care. Clients from around the country have been reaching out to the law firm with questions.<\/p>\n Requiring providers to discuss costs with patients, whether before or after services are provided, would pose a \u201csignificant burden,\u201d he said. Doctors and other providers typically don\u2019t know specifics about patient deductibles, cost sharing, or other insurance coverage details until after a claim is submitted to a health plan.<\/p>\n Health care services are different than refrigerators or other goods that people buy, doctors say. If a patient gets a colonoscopy and doesn\u2019t want to pay for it, \u201cit\u2019s not possible to take the service back,\u201d said Jerome Cohen, a gastroenterologist and the president of the Medical Society of the State of New York, which represents physicians. As for the proposed changes in the 2026 budget, Cohen said the medical society \u201cvery much appreciates the governor\u2019s efforts to try to fix this problematic financial consent requirement.\u201d<\/p>\n But patient advocates are pushing back. The current practice is \u201cunfair and it\u2019s wrong,\u201d said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, a nonprofit that has successfully pushed for passage of several medical debt-related laws in recent years. No patient should ever have to preemptively agree to pay whatever a provider charges, Benjamin said.<\/p>\n In a written response to questions, Danielle De Souza, a spokesperson for the state Department of Health, said that the proposed law change is justified, \u201cgiven the burden of this requirement on both patients and providers.\u201d De Souza didn\u2019t respond to a request for clarification about what those patient burdens are.<\/p>\n Helen Krim walked out of a doctor\u2019s office in the Bronx borough of New York City a few years ago rather than sign an open-ended form agreeing to pay for any services recommended by the doctor.<\/p>\n It was the first time that Krim, who is covered by Medicare, had visited that primary care practice. When she told them she didn\u2019t want to sign the form, she was told they wouldn\u2019t serve her unless she did.<\/p>\n \u201cI\u2019m one of those annoying people who actually reads the forms,\u201d the retired bank project manager said. \u201cIt\u2019s kind of like signing a consent to be scammed.\u201d She found another practice that didn\u2019t ask her to sign a similar form.<\/p>\n There are other consumer medical debt protections at the federal and state level. The federal No Surprises Act<\/a> restricts providers from billing consumers for out-of-network services in certain instances. It also requires providers to give good-faith cost estimates<\/a> for self-pay patients. The Consumer Financial Protection Bureau released a final rule<\/a> in January that would have removed medical debt from people\u2019s credit reports, but the rule\u2019s implementation has been frozen<\/a> by the Trump administration. Several states<\/a> besides New York have also taken steps to protect consumers with medical debt.<\/p>\n Benjamin said that simply requiring an unspecified \u201cdiscussion\u201d about costs doesn\u2019t address patients\u2019 potential unlimited financial liability. Under a bill that Benjamin\u2019s organization has drafted, providers would have to give patients a written good-faith estimate of their expected costs before the patient receives services and patients could not be held liable for unlimited or unspecified costs beyond that estimate.<\/p>\n \u201cLet\u2019s be the first state to really have fair rules of engagement for both the providers and the patients about what is it that you\u2019re agreeing to be financially liable for at the point, beforehand,\u201d Benjamin said.<\/p>\n The measure was introduced in the Senate this month.<\/p>\n Providers are taking a wait-and-see attitude, Mitchell said, because the budget plan must still move through the legislative process.<\/p>\n Another New York medical debt-related law that took effect in October takes aim at the use of credit cards to pay for medical services. The Hochul administration has not proposed changing it. The law prohibits providers from requiring pre-authorization of credit cards or keeping a patient\u2019s card on file. It also requires providers to notify patients of the risks of paying for medical care with credit cards, which may lack medical debt protections. In addition, providers aren\u2019t allowed to help patients complete credit card applications under the law.<\/p>\n The laws are aimed at stopping unfair billing practices and reducing medical debt for New Yorkers. Earlier laws ban credit reporting of all medical debt and prohibit hospitals from suing patients with incomes under 400% of the poverty level, among other things.<\/p>\n New York providers don\u2019t like the credit card law either, though it hasn\u2019t generated the pushback seen with the consent-to-pay law.<\/p>\n In a statement, Brian Conway, a spokesperson for the Greater New York Hospital Association, said, \u201cIt\u2019s important to clarify that hospitals do not oppose the goals of the hospital financial assistance law reforms overall, but rather the operational burdens and patient disclosure overload that a few specific provisions create.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n