Consumer complaints about receiving inadequate reimbursement or “surprise” bills from surgeries or procedures have been a growing problem in New York for some time. What you might not know is that a new law went into effect in March of 2015 aimed to help protect the patient from unforeseen medial services that they received outside of a provider network.
Here are Some Highlights of how the “Surprise Bill Law” May Help You:
- Consumers who receive emergency services will not have to pay more than their usual in-network cost sharing and/or copayments, regardless of the network status of the providers.
- Additionally, consumers who receive other out-of-network medical services when there were no in-network providers available or when they did not receive the disclosures required by this new law can assign their claims to the out-of-network providers and pay only their usual in-network cost-sharing. (The medical bill is negotiated by and between the provider and the health plan.)
- Prior to providing non-emergency services, providers must disclose to patients their right to know what will be billed for the procedure and, if the patient requests, they must disclose the anticipated cost.
- Providers must provide patients with their network and hospital affiliations in writing or online.
- When patients make appointments, providers must indicate whether they participate in a patient’s network.
- If other professionals will be involved in a patient’s care, the patient must be advised of who it might include and how to learn how much the network will cover for those doctors.
Additional Rules that Apply to Hospitals:
- Publicly post a schedule of charges for various services on their website and list the health plans in which they participate.
- Warn patients that physician services may not be covered by hospital bills and tell them how to check with physicians regarding their network affiliations.
- Post the names of practice groups for such services as radiology, anesthesiology, and pathology with which the hospital has a contract, along with information on how consumers can determine the network affiliations of those groups.
- Post information, including network affiliations, of doctors who are hospital employees (and give this information directly to patients when they register or are admitted for care).
The new bill is fairly extensive and this is just some of the highlights of the bill. If you are injured in an accident that was caused by someone else’s negligence you will want legal aid at your side. Our team of experienced personal injury lawyers will help you navigate the legal system and deal with difficult insurance companies. When “surprises” pop up, we’ll do our best to make sure your rights are being protected. For a no obligation, free case evaluation call us today at 516-222-4000.
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