New protections against surprise or out-of-network medical bills. Since March 31, 2015, New York consumers with health coverage subject to New York law (e.g. HMO) were protected by surprise bills from out-of-network medical providers. It’s A Surprise Bill At An In-Network Hospital or Ambulatory Surgical Center if an Out-of-Network Provider Treats You and:
An in-network provider was not available; OR
An out-of-network provider provided services without your knowledge; OR
Unforeseen medical services were provided when you received health care services.
It is NOT a surprise bill if you chose to receive services from an out-of-network provider instead of from an available in-network provider before you got to the hospital or ambulatory surgical center. The Federal No Surprises Act went into effect January 1st, 2022. As such, beginning January 1, 2022, the following services will usually be a surprise bill when provided by an out-of-network provider in a hospital or ambulatory surgical center: emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. If your health care services were before January 1, 2022, you are only protected from a surprise bill if you were treated by an out-of-network physician (and not other health care providers) at an in-network hospital or ambulatory surgical center.
Prior to the passage of the No Surprises Act, consumers who had self-insurance or health coverage sponsored by their employer or union were not entitled to protections from the New York Surprise Bill as this type of insurance could only receive protections from federal law, not state law. The Federal No Surprises Act now provides protections from surprise medical bills from an out-of-network provider in an in-network hospital or ambulatory surgical center apply if your employer or union self-funds your coverage for plans issued or renewed on and after January 1, 2022. You are only responsible for paying your in-network cost-sharing (copayment, coinsurance, or deductible) for a surprise bill. However, for plans issued or renewed before January 1, 2022, you may qualify for an independent dispute resolution (IDR) through New York State by submitting an IDR application to dispute the bill. To be eligible, services must be provided by a doctor at a hospital or ambulatory surgical center and you aren’t given all the required information about your care.
Nassau Suffolk Law Services provides legal representation and advice to eligible Nassau and Suffolk residents experiencing consumer debt problems (like student loans), especially in the matters of medical and credit card debt. Suffolk residents can call 631-232-2400. Nassau residents can call 516-292-8100.