Information provided by the Office of New York Attorney General Letitia James
New York Attorney General Letitia James recently reminded New Yorkers of new safeguards against surprise bills. She did this, her team said, “to protect consumers from unexpected and often devastating medical bills.”
The federal No Surprises Act, which went into effect on Jan. 1, builds upon existing New York law to shield New Yorkers from many unexpected medical bills. The new law prohibits hospitals and health care providers from billing patients for more than their in-network co-payment or deductible on many unexpected out-of-network bills.
“Unexpected medical bills can be a devastating blow for individuals and families, and take years to recover from,” James said. “New Yorkers should be able to seek necessary medical treatment without worrying about unanticipated financial hardship, but they first must know about the protections available to them. This additional support from the federal government will allow New Yorkers to focus on what’s really important: getting the care they need.”
Under both the No Surprises Act and New York law, hospitals and health care providers are prohibited from billing a patient for more than the in-network co-payment, co-insurance, or deductible costs for certain “surprise” out-of-network bills. These surprise bills include bills for:
√ Emergency services provided at emergency rooms or freestanding emergency departments. Emergency care includes screening and stabilizing treatment sought by patients who believe they are experiencing a medical emergency or are in active childbirth labor.
√ Non-emergency services provided at in-network facilities. Treatment by an out-of-network health care provider at an in-network hospital, hospital outpatient department, or ambulatory surgery center is covered under the law.
Air Ambulance Services
Additionally, the No Surprises Act has provisions that further protect consumers from getting entangled in billing disputes, including the required disclosure of all surprise billing protections directly to all patients and on the health care provider’s websites. Providers also now need to submit surprise out-of-network bills directly to patients’ health plan, so the health plan can send a payment to the provider and send the patient an explanation of benefits (EOB) indicating the amount the patient owes the out-of-network provider.
If a health plan applies out-of-network coverage to a surprise bill, patients have the right to appeal. Consumers may appeal the determination to the health plan and then, if the plan upholds its decision, to an independent external reviewer. The new guidelines apply to uninsured New Yorkers as well, for whom health care providers must provide good faith estimates of expected charges. If the amount charged is more than $400 over the estimate, the uninsured may elect to submit their bill for review.
In 2014, New York passed legislation to protect consumers from surprise medical bills. The “Surprise Bill” was the first of its kind in the nation and provides transparency to consumers to protect them from excessive bills when a patient unknowingly receives services from a physician who is not part of their health care plan’s network of providers.
Additional information regarding surprise billing can be found on the Office of the Attorney General website. Call the attorney general’s health care helpline at 1-800-428-9071, or visit the online portal if you believe that you have been improperly charged for a surprise bill by a health care provider, or that a health plan has improperly assessed cost-sharing for a surprise bill.