If you have commercial insurance New York State law may protect you from balance billing for emergency services and Surprise bills from out-of-network providers. If you are enrolled in a health plan that is subject to federal law (self-insured), you may be able to dispute out-of-network balance bills in a formal dispute resolution process.
Is your bill from an out-of-network emergency service?
- If you are enrolled in a fully-insured health plan: You cannot be billed for any out-of-network ambulance, emergency room, doctor, or post-emergency room inpatient hospital bills other than your regular in-network cost sharing.
- If you are enrolled in a self-insured health plan: You can be billed for out-of-network emergency services. You may dispute ambulance, emergency room, doctor, or post-emergency room inpatient hospital balance bills if you believe the provider charges are unreasonable. You can dispute the bill by filing an application for Independent Dispute Resolution. This process determines whether or not the provider charges are reasonable according to what other providers in your area charge for the same service.
Is your bill a “surprise bill” from an out-of-network provider?
You may have received a surprise bill and be protected from balance billing if:
- You went to an in-network hospital or ambulatory care facility and an out-of-network doctor treated you, without your knowledge, because: no in-network doctor was available; of unexpected medical complications or during the course of a visit with an in-network physician samples were collected and sent to an out-of-network lab; an out-of-network provider provided services; or you were referred to an out-of-network provider.
If you think you have a surprise bill, you can do the following:
- If you are enrolled in a fully-insured health plan you should be held harmless for surprise bills: Fill out an Assignment of Benefits form, available here.
Send a copy of this form to your health plan and the billing provider. You should keep a copy for your records as well. You should only pay your normal cost-sharing amount for these services.
- If you are enrolled in a self-insured health plan: You may be able to dispute the bill using an Independent Dispute Resolution process, if the out-of-network provider did not disclose that they were out-of-network prior to rendering services.
If you have questions or need help with an emergency service or Surprise Bill, please contact CHA at 888-614-5400.