Surprise Medical Bills—New Protections for Consumers

What healthcare providers need to know

David N. Hoffman
Chief Compliance Officer

New York State has enacted new laws that are designed to prevent “surprise” bills for medical services.

New York State Public Health Law (PHL) §24, requires physicians and other healthcare professionals to make disclosures to patients and prospective patients regarding out-of-network providers. The intent of this law is to enable healthcare consumers to make an informed decision regarding the use of “out of network” providers, and to avoid receiving surprise bills from providers who do not participate in patients’ health insurance plans.

The new law requires a healthcare professional to disclose to patients or prospective patients the following information:

• The health plans in which the healthcare professional is a participating provider
• The hospitals with which the healthcare professional is affiliated
• The amount or estimated amount that the healthcare professional will bill the patient for healthcare services (healthcare professionals are required to provide this information to patients prior to the provision of nonemergency services)
• Identifying information, including health-plan participation, for any other physicians whose services will be used (the hospital must also be informed)

If you would like more information on the new surprise billing law, visit www.health.ny.gov/regulations/public_health_law/surprise_bill_law or www.dfs.ny.gov/consumer/hprotection.htm

You can also contact the PAGNY corporate compliance program at 646-490-5340.