'No Surprises Act' protects New Yorkers from unexpected medical bills

NEW YORK (NEWS10) - On January 1, the federal 'No Surprises Act,' went into effect that builds upon existing New York law to shield New Yorkers from many unexpected medical bills. The new law prohibits hospitals and health care providers from billing patients for more than their in-network co-payment or deductible costs for certain “surprise” out-of-network bills

In 2014, New York passed The “Surprise Bill” which was the first of its kind in the nation groundbreaking legislation to protect consumers from surprise medical bills. The bill provides transparency to consumers to protect them from excessive bills when a patient unknowingly receives services from a physician who is not part of their health care plan’s network of providers. 

These surprise bills include: 

• Emergency services provided at emergency rooms or freestanding emergency departments
  • Including screening and stabilizing treatment sought by patients who believe they are experiencing a medical emergency or are in active childbirth labor
    
• Non-emergency services provided at in-network facilities
  • Treatment by an out-of-network health care provider at an in-network hospital, hospital outpatient department, or ambulatory surgery center is covered under the law

• Air ambulance services 
  • Medevac - air transport of trauma patients

In addition, the No Surprises Act protects consumers from getting entangled in billing disputes and requires the disclosure of all surprise billing protections directly to all patients and on the health care provider’s websites. Providers must submit surprise out-of-network bills directly to patients’ health plan, so the health plan can send a payment to the provider and send the patient an Explanation of Benefits which indicates the amount the patient owes the out-of-network provider. 

According to the bill, new guidelines apply to uninsured New Yorkers as well, for whom health care providers must provide good faith estimates of expected charges. If the amount charged is more than $400 over the estimate, the uninsured may elect to submit their bill for review. If a health plan applies out-of-network coverage to a surprise bill, patients have the right to appeal.