Late last week, a Health Affairs article described a new study on “surprise” medical bills. In New York State, “surprise bills” are bills from an out-of-network provider or out-of-network lab that a patient did not choose. These surprise out-of-network bills can lead to catastrophic medical debt and anxiety for consumers. The study found that 20 percent of hospital admissions that originated in the emergency department in 2014 were likely to lead to a surprise bill. In New York State, 30 to 40 percent of hospital inpatient admissions from the emergency department had the potential to result in a surprise medical bill.
In 2015, New York became the first state to enact legal protections to consumers facing surprise out-of-network bills. The Emergency Medical Services and Surprise Bills Law holds consumers harmless when they are treated by an out-of-network provider at an in-network hospital, or they are referred by an in-network provider to an out-of-network provider without their written consent.
New York’s surprise bills law also ensures that consumers who have New York State-regulated insurance no longer have to negotiate bills on their own. Insurance plans and providers can negotiate through an independent third party in a process called Independent Dispute Resolution (IDR).
For New Yorkers who get insurance through a job, through the Marketplace, or for New Yorkers who are uninsured, the Surprise Bill law provides they can dispute the bills through IDR.
If you think you have received a surprise bill, you can contact Community Health Advocates (CHA) for assistance.
Also, check out these great resources from CHA on surprise bills and emergency services: