Getting sick and seeking medical attention has never been more expensive than it is today. Even though 91.4% of Americans are insured, not all healthcare plans are the same and some out of pocket expenses and deductibles can be crippling. In fact, nationwide 17.8% of people with a credit report as of 2020 had medical debt in collections. 

These statistics are staggering and while it can be overwhelming to think about medical bills and debt, it is also important to know there are laws designed to protect you should you need them. Learn more about New York’s “surprise” medical bills law that went into effect on April 1, 2015, below and see how it can help you if you need it.  

This law gives doctors strict guidelines

In order to protect patients from “surprise” medical bills, this law has very specific guidelines that doctors must follow. These include:

• For non-emergency treatment, doctors need to advise you who their network and hospital affiliations are in writing and/or online. Additionally, they are required to let you know if they participate in your network when you call to make an appointment.
• Doctors must tell you that you have a right to know the amount that will be billed for a procedure before they provide you with any non-emergency treatments. If you inquire, they must also tell you the anticipated cost of that procedure.
• If there are other doctors involved in your case, you must be told who they are and how to find out how much your network will cover for these doctors. 
• A doctor that is in your network is not allowed to refer you to an out-of-network provider without your written consent.

Hospitals and healthcare facilities have guidelines too

In addition to doctors needing to legally provide you information regarding the cost of your care and the network they are in / other doctors are in that will be involved in your care, hospitals and healthcare facilities also have strict guidelines. These include:

• Hospitals and other healthcare facilities must tell you what doctors will be involved in your care/procedure, and what networks they are in.
• Hospitals are required to post a schedule of charges on their website and list the health plans they participate in.
• They must also warn you if doctor charges may not be included in your hospital bill and inform you how to check on the networks that the doctors participate in.
• Additionally, they will need to post the names of the different practice groups they are contracted with along with how to find out if they are in your network.

Circumstances when you are protected

There are a few specific circumstances where you are protected from hefty bills. First, if you receive emergency treatment, you will not have to pay anything more than your typical in-network costs/co-pays. If you received care from an out-of-network doctor when in-network providers were not available, or if you were not given the information required by this law, you will be protected. At this point you will be able to assign your claim to the out-of-network doctors and pay your typical co-pay/deductible while the bills are negotiated directly between your health plan and the doctors.

Even though this law has been in effect since 2015, you may still encounter a “surprise” bill. These can include bills when an out-of-network doctor treated you at an in-network hospital or surgery center and an in-network doctor was not available, or, an out-of-network doctor treated you without your knowledge. Another example of a “surprise” bill happens when an in-network doctor refers you to an out-of-network doctor without your written consent. This would include when your in-network doctor brings in an out-of-network doctor to treat you or sends your blood to an out-of-network lab for testing without your written consent.

How to seek help

If you receive a “surprise” bill or a bill for emergency services, the best course of action is to call the telephone number on your health plan ID card so that your health plan can negotiate with the doctor to resolve the claim. If you are still concerned with what your rights are as a patient under this important New York law, Mark T. Freeley is here to answer your questions. Mark can be reached at 631-495-9435 or at NorthShoreInjuryLawyer@gmail.com