The New York State Department of Financial Services ("DFS") has proposed an amendment to a regulation implementing New York's Out of Network Law following a recent report of a consumer who received surprise bills totaling hundreds of thousands of dollars that were not covered by his healthcare plan.
"We are taking this action to strengthen the law so that New Yorkers have all the information they need to avoid surprise medical bills," said the DFS superintendent, Linda A. Lacewell. "After hearing about − and resolving – a recent issue, we know that if it could happen to one consumer; it could happen to others."
Under the proposed amendment, healthcare plans that receive a claim for the services of a non-participating physician or a non-participating referred healthcare provider that could result in a surprise bill would be required to provide additional notice to the insured consumer. The notice would advise that the insured consumer may receive a surprise bill based on the claim and would include a description of surprise bills and the New York Out-of-Network Law's Independent Dispute Resolution ("IDR") process for surprise bills, as well as instructions on how to submit a dispute, a copy of an assignment of benefits form, and the healthcare plan's designated addresses for submitting the form. The notice would be included on or with the explanation of benefits.
The proposed amendment also would add a new section addressing cases where healthcare plans determine that services billed by a healthcare provider as emergency services are not emergency services. Among the steps the proposed new section would require, healthcare plans would have to notify insured consumers about surprise bills. The required notice must advise that consumers may receive a surprise bill for such services and that consumers may be protected from any such surprise bill. Those services also could be eligible for the IDR process. The notice would include the healthcare plan's contact information as well.
The proposed amendment also would require a healthcare plan that receives an assignment of benefits form and determines that a disputed bill is not a surprise bill to notify the consumer in writing of the procedures for filing a grievance or appeal and provide information on how to file a complaint with DFS. In addition, the proposed amendment would change disclosure requirements for non-participating physicians. Non-participating physicians who bill consumers for emergency services or a surprise bill would have to inform the consumer of the IDR process, along with providing the claim form and assignment of benefits form that non-participating physicians already must send with surprise bills.
Learn more: Proposed Amendment.
Victoria Spears
Victoria Prussen Spears is senior vice president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. A graduate of Sarah Lawrence College and Brooklyn Law School, Ms. Spears was an attorney at a leading New York City law firm before joining Meyerowitz Communications. She may be contacted at [email protected].