For more information, visit the CMS No Surprises Act website. You don’t need to do anything as part of this process. If the provider and your health plan don’t agree on a payment amount, the health plan or provider may send a dispute to CMS under the Federal independent dispute resolution process. The air ambulance provider and your health plan can negotiate the total payment amount to the provider. If air ambulance services are covered under your health plan, you are only responsible for your in-network cost-sharing, even if the service was from an out-of-network provider. For more information, visit the DFS Surprise Medical Bills webpage. These protections are increasing and will now include all providers, and not just doctors, for emergency services in hospitals.įor these bills, you are only responsible for your in-network cost-sharing. You are protected from bills for out-of-network emergency services in a hospital, including inpatient care following emergency room treatment until you are discharged from the hospital. You are covered for emergency services in a hospital if you have a medical or behavioral condition and you need immediate medical treatment. This includes services you get when you are in your doctor’s office, when your doctor sends a sample taken from you to an out-of-network lab or pathologist, and for other health care services when a referral is required and you received a referral from your in-network doctor.
You are also protected from surprise bills when an in-network doctor refers you to an out-of-network provider. These protections are increasing and will now include all providers, and not just doctors. You are protected from surprise bills when you are treated by an out-of-network doctor at an in-network hospital or ambulatory surgical center. Protections from Bills for Emergency Services and Surprise Bills See section below titled, “Protections for Consumers Who Have Self-Funded Employer Coverage.”)īelow is more information on your New York protections and how some of your protections may have changed because of the No Surprises Act. If you don’t see the phrase “fully insured coverage,” New York protections probably do not apply to your coverage. (Check your health plan identification card (ID card). Also, you may have different protections if your employer self-funds its employees’ health insurance.
If you or your employer purchased health insurance outside of New York, you should speak to your insurer about protections specific to that state. Most New Yorkers already have many consumer protections from surprise medical bills if they or their employer bought health insurance in New York.
Protections For Consumers Who Have Health Insurance The new protections start January 1, 2022. Health care providers should not bill you for any additional amounts. Under these new protections, you only have to pay your in-network copayment, coinsurance, or deductible for emergency services or when you receive a surprise bill. You may receive a surprise bill when you see a health care provider that is not in your health plan’s network (an out-of-network provider). The Federal No Surprises Act protects consumers from surprise medical bills and makes it easier for consumers to understand the costs of health care services before they get a service. Consumer Protections Under The Federal No Surprises Act
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