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NYS: New regulation to protect consumers who relied on incorrect provider network information


Thu, Dec 8th 2022 08:25 am

Gov. Kathy Hochul on Wednesday announced the New York State Department of Financial Services has adopted a regulation to “protect consumers from unfair, surprise costs when they relied on incorrect information in their insurer's health care provider directory.”

Her team said, “The new regulation addresses a longstanding concern for consumer advocacy groups by ensuring consumers who use providers they believe are in-network based on misinformation provided by their insurers will pay no more than their in-network cost-sharing. The governor included this initiative in her 2022 State of the State address.”

Hochul said, "New Yorkers should never be blindsided by surprise costs due to incorrect information in their insurer's health care provider directory. This new regulation will help protect consumers from surprise costs and ensure they pay no more than their in-network cost-sharing. This initiative is part of my administration's commitment to ensuring consumers are treated fairly, and I'm proud that we are taking this action to deliver on that promise."

Department of Financial Services Superintendent Adrienne A. Harris said, "Insurers are responsible for supplying accurate provider information, and consumers should be able to rely on that information as they make important decisions about medical care for themselves and their families. This long-overdue regulation is basic common sense – insurers should not profit by charging consumers out-of-network fees when the insurer was at fault for giving incorrect information that a health care provider was in-network."

Under the final regulation, provider directory misinformation occurs when:

√ A provider who does not participate in the insurer's network is incorrectly listed as an in-network provider in the insurer's online or hard copy provider directory;

√ In response to a consumer's request for information by telephone or through electronic means, an insurer indicates in writing that a provider is in-network when the provider is not in-network; or

√ An insurer fails to provide network status information in writing to a consumer within a certain number of days of the consumer's request for such information by telephone or through electronic means.

Hochul’s team said, “The regulation is consistent with the federal No Surprises Act requirements protecting consumers against provider directory misinformation.”

A copy of the final regulation can be found on the DFS website.

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