{"id":2586,"date":"2015-04-16T11:03:23","date_gmt":"2015-04-16T15:03:23","guid":{"rendered":"https:\/\/peakinsuranceadvisors.com\/?p=2586"},"modified":"2019-06-10T12:18:33","modified_gmt":"2019-06-10T16:18:33","slug":"ny-health-insurance-amends-law-surprise-bills","status":"publish","type":"post","link":"https:\/\/peakinsuranceadvisors.com\/ny-health-insurance-amends-law-surprise-bills\/","title":{"rendered":"NY Amends Health Insurance Law to Limit Out-Of-Network Surprise Bills"},"content":{"rendered":"<p><span style=\"color: #000000;\"><strong><span style=\"font-size: 14pt;\">New amendments to the NY Insurance Law: out-of-network benefits and services &#8211; Surprise Bills<br \/>\n<\/span><\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">by Anthem Blue Cross Blue Shield<\/span><\/p>\n<p><span class=\"posted_date\" style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">April 14, 2015<\/span><\/p>\n<p><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\"><span style=\"font-size: 8pt;\">&#8220;<\/span>New amendments to the New York Insurance Law went into effect April 1, 2015. Included in these amendments are new consumer rights regarding \u201csurprise bills\u201d and access to out-of-network benefits, as well as increased information for insureds about out-of-pocket costs for out-of-network services.<\/span><\/p>\n<p><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">The law includes key elements on \u201csurprise bills\u201d that may impact members including:<\/span><\/p>\n<ul>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">Updated protections from \u201csurprise bills.\u201d The concept of a \u201csurprise bill\u201d has been introduced for services by non-participating physicians and other providers, like labs. Surprise bills may occur if:<\/span>\n<ul>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">A member got a procedure at a hospital or surgery center that is in network. But while they were there, they also got care from a doctor who doesn\u2019t participate in their network and:<\/span>\n<ul>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">\u00a0A participating doctor wasn\u2019t available;<\/span><\/li>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">The member didn\u2019t know he or she was getting care from a non-participating doctor; or<\/span><\/li>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">An unexpected medical need required the member to get care from a non-participating doctor.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">A member was referred by a participating doctor to an out-of-network provider and the member didn\u2019t sign a consent form to show they understood there may be additional costs. For this purpose, a referral occurs when:<\/span>\n<ul>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">The member gets care from a non-participating provider in the same office, during a visit to the participating doctor.<\/span><\/li>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">The participating doctor takes a specimen, such as a tissue sample, that\u2019s sent to a non-participating lab or pathologist.<\/span><\/li>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">The member is referred to a non-participating provider by a participating doctor when referrals are required under the plan.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">If a member receives services that result in a surprise bill, the non-participating provider will be required to hold the insured member harmless if the member completes a new assignment of benefits form. The provider can then submit the claim to an independent dispute resolution entity (IDRE).<\/span><\/p>\n<p><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">Other provisions of the law include:<\/span><\/p>\n<ul>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">Expanded rights for reimbursement of emergency services to now include all types of plans (previously applied to HMO plans only). When a member receives emergency services from a non-participating provider, their out-of-pocket expenses can be no more than what would have applied to in-network services. The member is held harmless for charges beyond the in-network cost share amount.\u00a0<\/span><\/li>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">New cost disclosure requirements for providers and carriers when going out-of-network. Providers must now tell members whether they are in or out-of-network for a given plan, and their hospital affiliations, before they render non-emergency services or when an appointment is scheduled. The out-of-network provider must provide the estimated amount they will bill for non-emergency services upon request. For inpatient and scheduled outpatient hospital services, the facility must now identify any additional providers that will be rendering care to that patient.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">Members will also begin to see expanded information from us regarding costs, out-of-network reimbursement, and dispute resolution rights associated with out-of-network care, as well as when services are considered out-of-network. This language will now appear on EOBs, the<span class=\"Apple-converted-space\">\u00a0<\/span><span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"http:\/\/www.empireblue.com\/notices\/pages\/surprisebills.html\" target=\"_blank\" rel=\"noopener noreferrer\">notices and updates section<\/a><\/span>\u00a0of empireblue.com, and UM authorization and denial letters. Please note, the dispute resolution processes differ for disputes over ER bills versus those over surprise bills.<\/span><\/p>\n<p><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">There are other elements to the new amendments that went into effect on April 1. This article contains some highlights. For more information, you can read about them at the<span class=\"Apple-converted-space\">\u00a0<\/span><span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"http:\/\/www.dfs.ny.gov\/insurance\/ihealth.htm\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Financial Services (DFS) website<\/a>.<\/span> Always consult the Evidence of Coverage for complete coverage details and conditions.<\/span><\/p>\n<h3><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">This article applies to:<\/span><\/h3>\n<ul>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">New York<\/span><\/li>\n<li><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif; color: #000000;\">Small Group, Large Group, and Individual (under 65)<span style=\"font-size: 8pt;\">&#8220;<\/span><\/span><\/li>\n<\/ul>\n<p><span style=\"color: #3366ff;\"><strong><span style=\"font-size: 12pt; font-family: arial,helvetica,sans-serif;\"><a style=\"color: #3366ff;\" href=\"http:\/\/news.anthem.com\/bcp\/index.php\/articlepreview\/index.html\/new_amendments_to_the_ny_insurance_law_out_of_network_benefits_and_services\">Link To Original Article<\/a><\/span><\/strong><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>New amendments to the NY Insurance Law: out-of-network benefits and services &#8211; Surprise Bills by Anthem Blue Cross Blue Shield April 14, 2015 &#8220;New amendments to the New York Insurance Law went into effect April 1, 2015. Included in these amendments are new consumer rights regarding \u201csurprise bills\u201d and access to out-of-network benefits, as well [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"mc4wp_mailchimp_campaign":[],"footnotes":""},"categories":[339,1679],"tags":[83,84,85,57,86,87,41,88,89],"class_list":["post-2586","post","type-post","status-publish","format-standard","hentry","category-small-business-health-insurance","category-small-business-health-insurance-ny","tag-health-insurance-broker-long-island","tag-new-york-health-insurance-amendment-law","tag-new-york-health-insurance-broker","tag-ny-health-insurance","tag-ny-health-insurance-amendment","tag-ny-health-insurance-law","tag-obamacare","tag-out-of-network","tag-surprise-bills"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.4 (Yoast SEO v24.4) - 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