2015 NYS Law Gives Protection from Surprise Bills and Emergency Services

The NYS Surprise Bills for Health Care Services Law  went into effect in New York State March 31, 2015, protecting some consumers from "surprise bills" when services are performed by a non-participating (out-of-network) doctor at a participating hospital or ambulatory surgical center in your HMO or insurer's network or when a participating doctor refers an insured to a non-participating provider. This state law also protects all consumers from bills for emergency services. The law  can be found in the New York Financial Services Law Article 6 and NY Insurance Law Section 3241(c)

More recently, starting January 1, 2022, there are new federal protections that prevent surprise medical bills under the federal No Surprises Act (NSA), Pub. L. No. 116-260, 134 Stat. 1182, Division BB § 109.  If you have private health insurance, these new protections ban the most common types of surprise bills. If you’re uninsured or you decide not to use your health insurance for a service, under these protections, you can often get a good faith estimate of the cost of your care up front, before your visit. If you disagree with your bill, you may be able to dispute the charges.

This article describes more about the federal law and explains the differences between the state law and the federal law. 

Here is a link to the State Health Insurance Resource Center of the NYS Dept. of Financial Services, which thoroughly explains the state law-- https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills.  It explains what you need to know about these important new protections if:

  1. you have coverage with an HMO or insurer subject to New York law;
  2. you are uninsured or your employer or union provides self-insured coverage that is not subject to New York law; or
  3. you are a health care provider.

The article also describes the  Independent Dispute Resolution (IDR) Process  (Financial Services Law Article 6) and provides a link to the portal to  file a claim. 

Article ID: 213
Last updated: 03 Apr, 2022
Revision: 2
Private Insurance -> 2015 NYS Law Gives Protection from Surprise Bills and Emergency Services