New NY Law Protects Patients from Surprise Billings

IPRO and two other organizations have been authorized to adjudicate disputes that arise from billings for services provided by out-of-network providers. Effective April 1, patients in New York are protected from surprise billings in excess of network charges from out-of-network providers that take place in the absence of a written acknowledgements from patients authorizing out-of-network services. Disputes between providers and insurers over bills alleged as excessive by out-of-network practitioners are subject to resolution by independent organizations. In addition to IPRO, Independent Medical Expert Consulting Services of Lansdale PA and MCMC of Quincy MA were chosen by New York’s Department of Financial Services to arbitrate disputes over the costs of non-network charges. DFS says it received 10,000 complaints by patients over non-network charges since 2008. Experts suggest that formal dispute resolution will be minimized if providers and insurers rely on billing benchmarks available from Fair Health, the independent not-for-profit created in New York that collects and analyzes data on “usual, customary and reasonable” rates for healthcare services. For more information on the new law, visit DFS’s website at www.dfs.ny.gov.