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NY lawmakers request data to prevent insurance overpayments

Advocates estimate New York state could be overpaying for health care by $1 billion amid a widening disparity in hospital costs depending on where a person receives treatment.

Some lawmakers are working to figure out by how much.

“There’s a lot of data out there to show that hospitals across the board charge very variable costs, and with charges or fees to patients and under different insurance plans for some really basic care,” state Sen. Andrew Gounardes, a Democrat, said. from Brooklyn.

Gounardes and state Assemblywoman Catalina Cruz, a Queens Democrat, sent a letter to the commissioners of the civil service and state health departments asking for data to assess the costs of 1.2 million state workers who work at New York State Health Insurance Program is enrolled and how much the state pays its beneficiaries too much.

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

For example, an MRI scan for someone without insurance costs less than $500 at Mount 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.

In the letter, lawmakers asked the Civil Service Department a list of questions to determine which hospital systems are overloading for standard procedures.

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

“This will help us get an understanding of exactly how big a problem it really is,” Gounardes said.

Lawmakers chose to evaluate the state’s health insurance program, or data they control, to take a step toward equity in hospital affordability. But it’s an issue that affects all workers when they negotiate for their benefits.

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

Several unions and health providers joined forces 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 that the state is probably overpaying for health care by a billion dollars or more,” he said. “What can the state do with a billion dollars for other priorities than just pay more than they need for high-priced hospitals?”

Lawmakers have not given the Civil Service Department a deadline for receiving the data, but expect it could take several weeks as the state compiles information amid the open enrollment period.

“We are reviewing the letter. As health care costs continue to trend upward nationally, the Department of Civil 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 Civil Service Department when asked about the letter and costs of the state’s health plan.

The state health department regulates state hospitals and cannot oversee the state’s health plan, and referred all questions to the civil service department. The department will respond to the lawmakers’ offices about the letter to direct them to the other agency.

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