Early Results In on NY ‘Surprise Billing Law’

The landmark New York “Surprise Billing” law that went into effect last spring was intended to protect insured hospital patients from out-of-network co-payments, coinsurance and deductibles larger than charges for comparable in-network ancillary emergency services. The new law also protects insured New Yorkers from surprise balance billings for outpatient services as well, if they sign assignment of benefits forms permitting doctors to seek additional payments for disputed services from health plans and if they forward bills for disputed services to providers and to plans. New data from New York State’s Department of Financial Services (NFS) suggest that the law is being administered in a way that protects patients and seems fair to health plans and providers. According to analysis of the NFS data provided by the Crain’s Health Pulse news service, in 291 billing disputes between providers and plans over out-of-network emergency services, independent reviews found on behalf of health plans in 22% of cases and on behalf of providers in 13% of cases. According to Crain’s, independent review of emergency care billing disputes in amounts between $1,000 and $5,000 found on behalf of providers in 18 cases and for insurers in 20 cases. IPRO is one of the independent dispute resolution contractors brought in by New York State to adjudicate between plans and providers regarding the reasonableness of out-of-network billings. The National Academy for State Health Policy has just published a report analyzing surprise billing legislation in New York, a number of other states and at the federal level. The report, Answering the Thousand-Dollar Debt Question: An Update on State Legislative Activity to Address Surprise Balance Billing, is available at the NASHP website at www.nashp.org.