New York Latest State to Place Restrictions on Out-of-Network Billing

Posted By American Med Spa Association, Monday, August 24, 2015

New York became the 13th state to place restrictions on out-of-network billing by enacting legislation designed to protect consumers from receiving unexpected bills for out-of-network medical care. Under the "Surprise Medical Bill" law enacted April 1, health-care providers must routinely disclose: ■    The health plans in which they participate when an appointment is made ■    The hospitals with which they are affiliated (either in writing or online) ■    Anticipated charges for a given service, including a warning that total costs could be higher if complications occur ■    Names and contact information for other professionals who may be involved in any care provided (e.g., anesthesia, pathology, laboratory or X-ray services) Ensuring that adequate provider networks are available to meet consumers' needs is a primary goal of the law, which comes in response to an unprecedented number of consumers being billed for services rendered by out-of-network physicians. Insurance plans based on comprehensive provider-networks must now provide information in writing and online to allow consumers access to current listings of in-network providers. Consumers may seek services from out-of-network providers if they believe those in-network do not possess the expertise to provide adequate medical care. Payers must also make available consumer-driven tools to estimate out-of-pocket costs for care provided out-of-network. The estimates must be specific enough to reflect differences in costs by geographic regions. In addition, patients must agree to any referrals to out-of-network providers, but they may also choose to work with their insurance plans to locate an in-network provider. Prior to any out-of-network care, the patient must sign a consent acknowledging they were made aware that the care could result in costs not covered by the insurer.  Read more at Plastic Surgery News.