New York Expected to Pass Out-of-Network “Surprise” Hospital Bill

November 2019 ~

New York has released an amendment to certain regulations under a previously released state law that adds additional notice requirements for insurers and out-of-network (OON) providers.

Originally passed in 2014 and effective March 31, 2015, the Emergency Medical Services and Surprise Bills law (SBL) protects state residents from: “surprise” OON bills following emergency department visits, bills for services rendered at in-network hospitals and ambulatory surgery centers if no in-network physician was available to provide the care or an OON provider rendered the service without the insured’s knowledge, as well as bills for services rendered by an OON provider referred by an in-network provider without the express written consent of the insured.

The Patient Protection Act (S.3171/A.264B) amends the 2014 SBL law by prohibiting health insurance companies from charging members who were treated in out-of-network hospitals for emergency visits (as well as inpatient services following an emergency room visit) higher prices than they would in-network patients. Insurers would be given the ability to pay hospitals outside their networks what they consider reasonable for emergency care, rather than what the hospital charged.

The bill also requires that hospital charges for emergency services are subject to an independent dispute resolution process. Currently, if a health plan receives a claim that it believes may be a surprise bill and it is not accompanied by the AOB, the plan must advise the insured that the claim could be a surprise bill and that he or she should contact the plan or visit the plan’s website for additional information.  The proposed regulation adds that the plan must also provide a description of what constitutes a surprise bill, a description of the IDR process, the AOB form, the plan’s e-mail address for submitting the AOB form, and information on how the insured can submit the surprise bill to an IDR entity (the Notice Information).

“In an emergency, every second counts and it’s ridiculous to expect someone facing a potential life-or-death situation to first check and see if a hospital is part of their health insurance network,” Cuomo said in a statement. “With this new law, insurers will need to do the right thing and make sure patients aren’t strapped with excessive and potentially debilitating out-of-pocket costs tomorrow simply because they needed emergency room care today.”

The law goes into effect immediately.

Source(s): Crain’s New York; Peterson-Kaiser; Hudson Valley 360; National Law Review; New York State;