Spring has sprung for surprise bills protections

Posted April, 1 2015 by Amanda

Cartoon BillToday is the day that New York’s new surprise bills protection law went into effect! The new Emergency Medical Services and Surprise Bills Law will hold New Yorkers harmless from medical bills that result from the unexpected use of “out-of-network” providers. HCFANY worked closely with consumer groups, including Consumers Union, American Cancer Society and AARP, and New York’s Department of Financial Services (DFS) to help secure this law as a part of last year’s state budget.

Surprise bills occur in both emergency and non-emergency situations. One common example is when an out-of-network surgeon or anesthesiologist steps in to assist in an otherwise in-network procedure. Other cases happen when New Yorkers are taken to out-of-network emergency rooms, sometimes unconscious, and charged exorbitant amounts for these services (as happened to Gladys). In the past, bills could be staggeringly high, threatening a family’s finances. They were also surprisingly common – these types of consumer complaints were #1 for the DFS and Attorney General’s office. Importantly, before the surprise bills law, New Yorkers were left on their own to either pay these bills, negotiate, or go broke.

A different story starts today, as the new law:

  • Holds consumers harmless from out-of-network emergency bills and non-emergency claims where an in-network provider isn’t available or proper disclosures about network status are not made. Consumers will only have to pay in-network cost-sharing in these situations.
  • Ensures that consumers will no longer be left to negotiate surprise bills on their own. Instead, bill negotiation will be left to providers and plans through an independent third party.
  • Improves disclosure by insurance plans and providers, so that consumers can make informed decisions when purchasing a plan and scheduling services. This prevents surprise bills in the first place.
  • Holds more plans to network adequacy standards and review.
  • Makes the claim submission process more consumer friendly.

We are proud to have been a part of the substantial efforts of consumer groups and the Cuomo Administration to make this law a reality. Let the celebrations begin!

You can read the full press release from the Cuomo Administration here.

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