By: Mathew J. Levy, Esq.
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In order to avoid patients receiving “surprise bills” from out-of-network providers and to help patients make informed decisions with respect to care, as of March 31, 2015, physicians and other healthcare professionals are now required to make certain disclosures to patients with respect to out-of-network providers (Public Health Law §23). It is imperative that health care providers comply with these new disclosure requirements, as failure to comply may be considered misconduct as defined by New York State Education Law, which may result in fines and penalties, including but not limited to the loss of a healthcare provider’s license.

In accordance with the new disclosure requirements, prior to the provision of non-emergency services, health care professionals, group practices of health care professionals, and diagnostic and treatment centers (hereinafter “Providers”) must disclose to patients or prospective patients verbally at the time an appointment is scheduled and in writing or through an internet website the health care plans in which they are participating providers and the hospitals with which the Providers are affiliated

Furthermore, if the Provider does not participate in the network of a patient’s or prospective patient’s health care plan, the Provider must inform the patient that upon the patient’s request, he/she will be provided with the amount or estimated amount the Provider will bill for such services. If such request is made, the Provider must disclose to the patient or prospective patient in writing the amount or estimated amount that will be billed to the patient, absent unforeseen medical circumstances that may arise.

Patients and prospective patients must also be provided with the name, practice name, mailing address, and telephone number of any health care provider scheduled to perform anesthesiology, laboratory, pathology, radiology or assistant surgeon services in connection with care to be provided in the physician’s office for the patient or coordinated or referred by the physician for the patient at the time of referral or coordination of services.

When a patient is scheduled for a hospital admission or outpatient hospital services, the patient and hospital must be provided with the name, practice name, mailing address and telephone number of any other physician whose services will be arranged by the physician, as well as information as to how to determine the health care plans in which the physician participates.

The new legislation also provides a dispute resolution process to handle emergency services or surprise bills. The Superintendent of the Department of Financial Services has the authority to grant and revoke certifications of Independent Dispute Resolution entities to conduct the dispute resolution process.  (Financial Service Laws §601.)

Conclusion

It is important for physicians and other health care professionals to comply with the Patient Disclosure requirements of Public Health Law Section 24.  Failure to comply with the requirements of the law may subject the physician to fines and other penalties.  In addition, while it is not the purpose of the article to discuss the Dispute Resolution Process to be established under Article 6 of the Financial Services Law, compliance with the requirements of Public Health Law §24 may avoid a “Surprise Bill” that is subject to the Dispute Resolution Process. 

Mathew J. Levy is a Partner of the firm and co-chairs the Firms corporate transaction and healthcare regulatory practice. Mr. Levy has particular experience in advising health care clients with respect to contract issues, business transactions, practice formation, regulatory compliance, mergers & acquisitions, professional discipline, healthcare fraud & billing fraud, insurance carrier audits including prepay and post payment review, litigation & arbitration, and asset protection-estate planning. You can reach Mathew Levy at 516-926-3320 or email: mlevy@weisszarett.com.