The "Emergency Medical Services and Surprise
Bills" law ("Surprise Bill Law") that went into
effect in New York on March 31, 2015 imposed a complex set of
required disclosures on healthcare providers. The primary
goal of the law, passed as part of the state's 2014-2015
budget, was simple enough: to protect consumers from
"surprise" medical bills after receiving care from
out-of-network providers. In attempting to achieve that goal,
however, the law amended numerous sections of the state's
insurance law and added still others, sometimes with ambiguous
language that left some providers confused as to their disclosure
obligations.
One relatively straightforward portion of the Surprise Bill Law
deals with services rendered in hospital emergency
rooms. Patients who have insurance are responsible only
for the copayments and deductibles that would apply to in-network
services, even when those services are provided by out-of-network
physicians.
More complex are the law's requirements that a healthcare
provider disclose certain information to patients, including the
provider's hospital affiliations, which health plans the
provider participates in, the provider's expected charges
to the patient, and the identities of any other professionals who
may be involved in the patient's care and who will bill for
their services (such as anesthesiologists) so that the patient may
then determine those providers' affiliations. Hospitals
must also post information including a list of charges and the
health plans in which the hospital and its personnel participate,
and health plans must also disclose information to their insureds
regarding "surprise bills" and the new dispute resolution
procedures mandated by the law.
For non-emergency services, a failure to provide such disclosures
and obtain patient consent will result in the
provider's bill being deemed a "surprise bill,"
upon which the patient will be responsible only for the health
plan's in-network cost-sharing amounts.
The New York State Department of Financial Services has a page on
its website explaining the Surprise Bill Law for
consumers and healthcare providers, and the state Department of
Health prepared a helpful summary of the new disclosure requirements for
hospitals.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
