Ny Surprise Bill, (1) For a surprise bill involving an insured, the health care plan shall pay the non-participating provider in accordance with paragraphs two and three of this subsection. If you receive a bill for emergency services or a surprise bill, contact your health plan, or your employer for self-insured coverage. Under New York State’s Surprise Bill Law, patients do not have to pay OON provider charges for surprise OON services that are higher than the patient’s standard INN copayment, deductible, or coinsurance. Your health plan must pay your health care provider, and your provider cannot bill you, except for any in-network cost-sharing. And New York law only covered surprise bills from doctors and hospitals. 1 In 2009, then Attorney General Cuomo fought for groundbreaking settlements with What is a surprise bill? A surprise bill is an unexpected bill you receive from a health care provider or facility who is out-of-network with your health insurance plan. This issue brief provides details on New York’s groundbreaking 2014 surprise bill legislation, the impact of the law to date, and further enhancements that can be made to continue New York’s leadership on an issue that is increasingly receiving attention as a pro-consumer and pro-price transparency priority. As Congress considers legislation to end surprise medical billing, some are looking at lessons learned from New York's experiment with "baseball-style" arbitration. In 2014, New York passed The “Surprise Bill” which was the first of its kind in the nation groundbreaking legislation to protect consumers from surprise medical bills. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. (2) The non-participating provider may bill the health care plan for Insurance Rights New Yorkers have special health insurance rights. The federal NSA law and NY’s Surprise Bill law both cover IDR billing disputes for (1) emergency services (and certain in-patient visits following an emergency doctor visit) and (2) surprise bills from all out-of-network health care providers. The out-of-network provider performs services at a participating (network) hospital or ambulatory surgery center and: In 2014, New York passed The “Surprise Bill” which was the first of its kind in the nation groundbreaking legislation to protect consumers from surprise medical bills. Out-of-Network Guidance What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. If your insurance ID card says, “fully insured coverage,” you can’t give up your protections for these other services if they are a surprise bill. Laws of New York Law , Financial Services Law; Article 6, Emergency Medical Services and Surprise Bills. If your health insurance plan is subject to New York State law, and you receive a surprise bill because: you were referred to an out-of-network provider by an in-network doctor; OR State health officials have tabled a new law designed to protect patients from surprise medical bills following backlash from providers who said it could put them out of business. Stay updated with the latest news and stories from around the world on Google News. The out-of-network provider performs services at a participating (network) hospital or ambulatory surgery center and: § 607. (a) Surprise bill involving an insured. What is “balance billing” (sometimes called “surprise billing”)? NEW YORK STATE SURPRISE MEDICAL BILL CERTIFICATION FORM You are protected from surprise medical bills. The NY Independent System Operator, which oversees the electric grid, weighed in on why electric bills are surging. You can choose a provider or facility in your plan’s network. You also aren’t required to get out-of-network care. The governor’s proposed fiscal year 2026 budget revises a law designed to limit unexpected bills that can put people at risk for unfair medical billing practices and reduce medical debt. You’re never required to give up your protections from balance billing. The No Surprises Act protects patients from large and unexpected surprise bills for out-of-network emergencies and certain non-emergency services provided in in-network health care facilities Summary of New Disclosure Requirements for Hospitals - New York State Public Health Law Section 24 (PDF, 239KB) Emergency Medical Services and Surprise Bills Law: Frequently Asked Questions Other Links These are links to the Department of Financial Services (DFS) web site for additional information and guidance materials. Consumer groups say it doesn’t go far enough. Surprise Medical Bills Protections Under New York law, most people are protected from surprise bills from doctors, hospitals, and other health care providers when they haven't given you all of the required information about your care. Your Rights and Protections Against Surprise Medical Bills When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. Check your plan documents for more details on balance bills. The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. This applies to members enrolled in health plans subject to New York regulations. gov for information about your rights under state law. Consumer Protection Under The Federal No Surprises Act The Federal No Surprises Act protects you from surprise medical bills and makes it easier for you to understand the costs of health care services before you get a service. The answer might surprise you. New York’s Emergency Medical Services and Surprise Bills law went into effect yesterday, which means consumers who receive out of network (OON) emergency services will no longer have to pay more A New York law that took effect in March 2015 (Financial Services Law Article 6) protects patients from “surprise bills” — meaning bills for health care services, other than emergency services, that are performed by an out-of-network provider at an in-network hospital or in-network ambulatory surgical center (a nonhospital health care New York’s Emergency Medical Services and Surprise Bill Act was created to protect patients from unexpected charges when they receive emergency treatment from an out-of-network provider. Call the phone number on your health plan ID card. ” Learn more. gov. However, while the NSA protections are similar to those already provided in New York, there are differences in the federal provisions that expand the New York protections in certain circumstances. Surprise bills are when you’re at an in-network hospital or ambulatory surgical facility and a participating doctor was not available, a non-participating doctor Since New York has a specified state law, the New York IDR process will continue to apply to out-of-network emergency services and surprise bills. Consumers in New York are protected from surprise bills when treated by an out-of-network provider at a participating hospital or ambulatory surgical center in their health plan’s network. A version of this article appears in print on , Section A, Page 17 of the New York edition with the headline: New Rule Steers How Arbiters Settle Disputes Over Surprise Medical Bills. ABOUT NY&C NY&C X ThredUp Influencers & Affiliates THE STYLE GUIDE Reviews CONTACT US VIP Rewards Give $25 Get $25 Get Paid To Post COUPONS & DEALS NY&C Gift Card Sign Up For Texts TRACK MY ORDER HELP CENTER RETURN POLICY RETURNS & EXCHANGES Runway Rewards Credit Card Log In & Pay Bill New York has always been a leader in protecting consumers from surprise medical bills. a comprehensive approach to addressing bills for emergency services and surprise bills from out- of-network (OON) doctors and other health care providers, and ensures that consumers are protected. If you think you’ve been wrongly billed and your coverage is subject to New York law (“fully insured coverage”), contact the New York State Department of Financial Services at (800) 342-3736 or surprisemedicalbills@dfs. The new federal law covers such bills from all health care providers, so that protection will now apply in New York. ny. Also, under the NY Surprise Bill Law, the insurer’s obligation to send payment directly to the provider is triggered by the patient’s completion of an AOB. Under these new protections The New York Surprise Bill Law and the NSA provide further protections for NY consumers, including those with private health insurance. What to Do if You Get NEW YORK STATE SURPRISE MEDICAL BILL CERTIFICATION FORM You are protected from surprise medical bills. Emergency Services and Surprise Bills What is a surprise bill? A surprise bill is a bill you receive for covered services performed by a non -participating (out-of-network) health care provider in the following circumstances: 1. New York’s Emergency Medical Services and Surprise Bill Act was created to protect patients from unexpected charges when they receive emergency treatment from an out-of-network provider. Refreshed: 2026-02-07 A version of this article appears in print on , Section B, Page 4 of the New York edition with the headline: Most Surprise Medical Bills Are Now Illegal, but You Still Must Be Careful. The NSA sets a floor for consumer protections and will work in coordination with New York State’s existing health care consumer billing protections that became effective March 31, 2015 via the New York Emergency Medical Services and Surprise Bills Law: Frequently Asked Questions Overview 1. New York will select an independent dispute resolution entity (IDRE) to review claims for emergency services and surprise bills where the payment amount can’t be agreed upon. If You Have Health Insurance If you have health insurance coverage subject to NY Law that you or your employer bought in New York, then you are protected from a surprise medical bill or a bill for emergency services. Surprise bills are when you’re at an in-network hospital or ambulatory surgical facility and a participating doctor was not available, a non-participating doctor provided services without your knowledge, or unforeseen medical services were provided. Department of Financial Services (DFS) is amending the NY surprise billing law to “apply federal requirements to the NY IDR process. Dispute a Surprise Medical Bill You can submit a dispute through the Independent Dispute Resolution (IDR) process for surprise bills for emergency services. What should I do if I get a surprise bill or a bill for emergency services? If you receive a bill from an out-of-network provider and believe it is a surprise bill or a bill for emergency services, do not pay the provider. What is a surprise bill? A surprise bill is an unexpected bill you receive from a health care provider or facility who is out-of-network with your health insurance plan. dfs. You may receive a surprise bill when you see a health care provider that is not in your health plan’s network (an out-of-network provider). In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible. The law applies when that care is delivered at a hospital or ambulatory surgical center that participates in the patient’s insurance network. balance bill you, unless you give written consent and give up your protections. g. Dispute resolution for surprise bills. Out-of-Network Guidance In 2015, the "Emergency Medical Services and Surprise Bills" law, commonly referred to as the "Surprise Bills Law", was passed to protect consumers against unknowingly receiving care from out-of-network providers and facing surprise medical bills. Feb 1, 2025 ยท This article will explore how New York’s legislation defines surprise bills, outlines the process for resolving disputes, examines penalties for non-compliance, and highlights the legal protections available to safeguard patient rights. A surprise bill is a bill you receive for covered services performed by a non-participating (out-of-network) health care provider in the certain circumstances. . Providers and patients must know about New York State Medical Billing Laws alike so they can both take informed decisions when needed. New York State Out-of-Network Surprise Medical Bill Assignment of Benefits Form Use this form if you receive a surprise bill for health care services and want the services to be treated as in-network. The Department The NYS Surprise Bills for Health Care Services Law went into effect in New York State March 31, 2015, protecting some consumers from "surprise bills" when services are performed by a non-participating (out-of-network) doctor at a participating hospital or ambulatory surgical center in your HMO or insurer's network or when a participating Your Rights and Protections Against Surprise Medical Bills This notice explains how you can get help with unexpected bills from out-of-network providers. “Out-of-network If we are unable to assist you directly, you may contact the New York State Department of Financial Services at 1-800-342-3736 or surprisemedicalbills@dfs. Your Rights and Protections Against Surprise Medical BillsWhen you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. The NY Surprise Bill Law provides a similar balance billing ban, but ties the ban to the patient’s completion of an AOB. This can happen when you can’t control who is involved in your care – like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. How does Public Health Law §24 prevent patients from getting surprise bills? Subdivisions (1) through (2) apply to health care professionals in private practice and diagnostic and treatment centers, including health centers under 42 USC §254b. You will need to sign the NY Surprise Medical Bill Certification Form and send it to your health plan if you receive a surprise bill. You will only have to pay your in-network cost-sharing. “Surprise billing” is an unexpected balance bill. Consumers in New York are protected from surprise bills when treated by an out-of-network doctor at a participating hospital or ambulatory surgical center in their health plan’s network. Diagnostic and treatment centers are health care facilities Summary of New Disclosure Requirements for Hospitals - New York State Public Health Law Section 24 (PDF, 239KB) Emergency Medical Services and Surprise Bills Law: Frequently Asked Questions Other Links These are links to the Department of Financial Services (DFS) web site for additional information and guidance materials. HMO) were protected by surprise bills from out-of-network medical providers. This protection began with the groundbreaking passage of the nation’s first surprise-medical-bill law, as part of the New York Financial Services Law. NEW YORK STATE INDEPENDENT DISPUTE RESOLUTION FOR EMERGENCY SERVICES AND SURPRISE BILLS health care provider (provider) or HMO/insurer (health plan) may dispute a payment or charge for emergency services, including inpatient physician and hospital services after an emergency room visit, or for a surprise bill. Contact CMS at 1-800-985-3059 for self-funded coverage or coverage bought outside New York. NEW YORK – New York Attorney General Letitia James today continued her efforts to protect consumers from unexpected and often devastating medical bills by reminding New Yorkers of new safeguards against surprise bills. Since March 31, 2015, New York consumers with health coverage subject to New York law (e. Visit www. taxem, wo9z, 8quixs, nnavlc, pul7mp, di1bt, ach0, garm, ygapbn, y7y9,