The "Emergency Medical Services and Surprise Bills" law, passed as part of New York state's 2014-15 budget, takes effect this month to protect consumers from unexpected "surprise bills" from nonparticipating medical care providers. It affects consumers with insured health plans in New York, with the exception of Medicare Advantage plans.
Doctors and hospitals will now be required to disclose more information to patients, including informing them prior to non-emergency procedures if they participate with certain health insurers; and what their hospital affiliations are. They must also provide information about other health care providers treating the patient, such as anesthesiologists. If they don't participate in a patient's health plan, doctors can — upon request — provide the patient with an expense estimate.
Health insurers must cover a nonparticipating provider the same as an in-network provider if there is no local participating provider available with the appropriate training and experience to provide treatment, or if the patient was referred to an out-of-network provider without disclosure or consent. Patients who receive emergency services from a nonparticipating provider can incur no greater out-of-pocket expense than they would have from a participating provider.
For details, visit http://fairhealthconsumer.org/reimbursementseries.php?id=74&terms=new-protections-for-new-york-consumers. To avoid surprise expenses, contact your doctors, hospitals and health plan to determine who participates in your plan.
— Sue Klug