Firm News & Legal Alerts

Tuesday, December 8, 2015

AG’s Office Begins Enforcing the Surprise Bill Law

This past Spring, the Surprise Bill Law took effect in New York State, imposing various disclosure and billing requirements on out-of-network providers and insurance companies. The aim of the law is to protect consumers from “surprise” or emergency out-of-network medical bills. Patients who receive surprise bills are to be held harmless, with the exception of their usual in-network co-pays and deductibles. Out-of-network providers and insurance companies are required to resolve any fee disputes in an arbitration-style format.

To help consumers avoid incurring unexpected medical costs in the first instance, the Surprise Bill Law requires physicians to disclose on their websites, or in writing, the insurance companies with which they participate. Physicians must also verbally disclose their network participation status to patients who are booking appointments.

This past July, the Attorney General’s Office (the “AG’s Office”) put 20 urgent care centers on notice that their websites did not comply with the disclosure requirements. According to the AG’s Office, the websites lacked clarity or were inaccurate, which could lead to patients unknowingly incurring significant medical bills.

The 20 urgent care centers had the opportunity to respond to the AG’s Office. While the AG’s Office was seemingly satisfied with most of the responses it received, they determined that the responses of four of the urgent care centers were either incomplete or unclear. As a result, the four urgent care centers each entered into an agreement with the AG’s Office that required them to make several changes to their websites and practices. Among the requirements are:

  • Identifying on their respective websites all of health plans with which they are contracted. If they only participate with certain products offered by insurance companies, they must identify those products with specificity;
  • Posting and providing their participation status in writing to the patient at the time of registration; Ceasing use of the terms “works with” or “accepts” with respect to insurance plans. Instead, the urgent care centers must specify “in-network” or “out-of-network” and explain that “out-of-network” will lead to higher charges;
  • Taking steps to hold the patient harmless in the event the proper information is not communicated to the patient;
  • All of the health care providers who bill at the urgent care centers must participate in all of the insurance companies in which the respective urgent care center participates; and
  • Disclosing to patients, upon request, the estimated costs associated with the services.

While many of these conditions, such as disclosing estimated costs upon request, are already codified in the Surprise Bill Law, other requirements are unique to these agreements. For example, while insurance companies frequently require medical practices and urgent care centers in their networks to contract only with in-network physicians, that requirement is not specified in the Surprise Bill Law.

The first enforcement of the Surprise Bill Law should serve as an alert to out-of-network providers, including those who participate in a select few insurance plans. While the AG’s Office limited the scope of their first investigation to urgent care centers, the Surprise Bill Law applies to all out-of-network physicians and medical practices in New York State. Urgent care centers, medical practices and out-of-network providers should consider implementing appropriate changes to their practices and marketing materials to comply with the Surprise Bill Law. 


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