The consumer protections of New York’s “Emergency Medical Services and Surprise Bills” law go into effect on March 31st of this year. This law provides needed insulation from unexpected and previously unavoidable bills from out-of-network providers. One of the more frequent billing complaints I have addressed concerns out-of-network providers that bill for services performed during a surgical procedure. If an out-of-network doctor treats a surgical patient while they are under sedation, is that really fair? Obviously it’s not and the New York law protects consumers against this practice. That doctor’s reimbursement is now limited to the in-network allowable charge.
Another complaint high on the list is charges from out-of-network providers referred unknowingly by an in-network doctor. These patients were just following their in-network doctor’s advice. Under the law, reimbursement is limited without proper disclosure. And if a participating doctor sends testing to a non-participating lab without disclosure, reimbursement is limited to the in-network charge. Patient responsibility for all emergency room charges will be limited to in-network cost-sharing regardless of whether the provider is in the network.
New York’s new law establishes an independent dispute-resolution entity (IDRE) which will be the arbiter of disputes under the law and my guess is that this entity will be pro-consumer. Hospitals will now be required to disclose anticipated charges. Providers will need to provide patients with disclosures of the health plans with which they participate and the names of the providers that may be billing them. They are also required to disclose procedures to follow with the IDRE if a patient feels that a bill is inappropriate.
Previously, consumers were stuck in the middle of health plan rules and provider’s medical practices; no longer in New York and it’s about time.