Is the bill correct?
Some important questions to consider when resolving medical bills are:
- Was the provider/facility in-network?
- Was the claim processed correctly?
- What is the cost sharing (deductible, co-pay or co-insurance) you are responsible for?
- Are there Federal or New York State laws that apply?
If you have commercial insurance, Federal and New York State law may protect you from balance billing for emergency services and Surprise bills from out-of-network providers.
Is your bill a “surprise bill” from an out-of-network provider?
A surprise bill is an unexpected bill you receive from a health care provider or facility who is out-of-network with your health insurance plan. Your health plan may cover none or only part of the out-of-network cost, and the provider or facility may bill you for the difference between the billed amount and the amount your health plan paid. This is called “balance billing.”
The NO SURPRISES ACT gives everyone some level of protection against surprise medical bills.
- Everyone means people with any kind of health insurance and people who are uninsured or choose to get medical care without using their insurance (“self-pay” patients)
Not all bills that come as a surprise are surprise bills! Read more about the Federal NO SURPRISES ACT and New York State’s Surprise Bill and Emergency Services law, their protections for certain out-of-network emergency- and non-emergency care situations, and how to dispute surprise bills: What is a Surprise Bill? What to do if you get a Surprise Bill?
What are NOT surprise medical bills?
Bills for the following types of care are NOT surprise bills under NY state and federal law:
- Services your plan denies coverage for as not medically necessary or experimental.
- You can still challenge the plan’s decision through your plan’s appeals process.
- Care you choose to receive from an out-of-network provider instead of from an available in-network provider.
- Out-of-network balance bills for ground ambulance rides, except if you have NY regulated insurance.
- Out-of-network balance bills for non-emergency services provided in certain facilities such as birthing centers, clinics, hospice, addiction treatment facilities, nursing homes, or urgent care centers
You can still challenge the plan’s decision through your plan’s appeals process. Please see information on How to Fight a Denial.
If it is determined the bill is your responsibility, the following resources can help reduce the amount owed if you cannot pay: DIY Debt Negotiation (English) or (Spanish) and Hospital Financial Assistance.
If you have questions or need help with a medical bill, please contact CHA at 888-614-5400.