The law protects New York State consumers from certain “surprise bills” related to charges for “out-of-network” doctors and emergency hospital visits.  This situation can occur when the patient was not aware the physician was out-of-network, or when circumstances required the use of an out-of-network physician. For example, a patient could have a scheduled surgery with an in-network surgeon but be unaware that the anesthesiologist was out-of-network. Or a patient having a severe cardiac event could be billed for out-of-network care administered at the nearest hospital, even though the patient was in an emergency situation and could not have safely sought an in-network provider.  These surprise charges can be substantially higher than when the same service is provided by an in-network provider.  Under New York State’s surprise bill law, in most circumstances patients no longer have to pay out-of-network provider charges for surprise out-of-network services that are higher than the patient’s standard in-network copayment, deductible, or coinsurance rate.

Under the law, a health care provider may dispute a payment or charge with an insurer through an IDRE (Independent Dispute Resolution Entity).  Barshay, Rizzo & Lopez, PLLC handles these disputes on behalf of its medical provider clients.