Surprise Bill Law Enhancement

On October 17th, 2019 Governor Cuomo signed legislation protecting patients from excessive emergency room charges relating to a patient receiving services from an out-of-network provider. The Legislation (S.3171/A.264B) improves the 2015 Emergency Medical Services and Surprise Bills law by allowing patients to avoid greater out-of-pocket costs than they would have incurred from a participating provider. The law goes into effect immediately.

Traditionally any services provided in an emergency room are treated as in-network, even if the hospital isn’t “in” your insurance carriers network. The thought being that in an emergency situation you don’t have the luxury of notifying first responders of your preferred treatment center – nor do they really care. The enhancement to the law addresses the point at which the patient is admitted to the hospital. Health plans treat the charges for being admitted separately than the emergency room service. Therefore, if being treated at a non-network facility the patient would be considered “out-of-network” for the room and other inpatient charges.

The enhancements to this law are designed to protect the insured, or subscriber. The insured will not pay more than what their in-network benefits would require of them if they were being treated in a network facility. Should the hospital charge more than the insurance company allows for the services, the State is setting up an independent dispute resolution process to handle the billing dispute.

Most enrollees of employer sponsored plans are rarely affected by being admitted to a non-network hospital. However, as the health insurance market continues to try to address spiraling premiums some carriers are offering plans with smaller, limited networks. And, smaller insurance companies, like the ones offering lower costs plan on the individual Exchange, may experience these issues.

If you have question about your plan or what it covers feel free to contact us to review your benefit plan.