1. New York’s new law helps protect patients from “surprise” medical bills, and went into effect on April 1, 2015.
2. For non-emergency treatment, doctors must advise you in writing or on line who their network and hospital affiliations are. The doctors must tell you when you call to make the appointment if they participate in your network.
3. The doctor must tell you that you have a right to know what amount will be billed for a procedure before they provide you with non-emergency treatment. They must also tell you the anticipated cost of the procedure if you ask.
4. If other doctors will be involved in your care, you must be told who the doctors are, and how to find out how much your network will cover for those doctors. A doctor in your network cannot refer you to an out-of-network provider without your written consent. Hospitals and other health care facilities must also tell you what doctors will be involved in your care/procedure, and what their networks they are in.
5. Hospitals must post a schedule of charges on their website; list the health plans they participate in; warn patients that doctor charges may not be included in hospital bill, and how to check on the networks that the doctors participate in; post the names of the different practice groups contract with, and how to find out if they are in your network.
6. If you receive emergency treatment, you will not have to pay anything more than your typical in-network costs/co-pays.
7. If you received out-of-network medical treatment when in-network providers were not available, or if you were not given the information required by this law, you will be protected. You will be able to assign your claim to the out-of-network doctors and pay your typical co-pay/deductible. The bills will be negotiated directly between your health plan and the doctors.
8. A “surprise” bill is a bill you receive for covered treatment performed by an out-of-network doctor. Here are examples of how you may receive a “surprise” bill:
a. The out-of-network doctor treats you at an in-network hospital or surgery center and an in-network doctor was not available, or, an out-of-network doctor treats you without your knowledge.
b. 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.
9. 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.
I hope this summary helps to you to better understand your rights as a patient under this important new law. If you have any questions, please feel free to contact me at 631-402-5527.
Mark T. Freeley, Esq.