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Part of what makes the American healthcare system so complex is the way in which services are billed and paid for. You may have health insurance, do all of your homework, select physicians and other providers who are in-network with your insurance company, and still receive an unexpected bill from an out of network provider. And studies show that these surprise bills can be for exorbitant amounts of money.

If this all-too-common scenario happens to you, don’t panic. You have a few options as well as protection by New York State law.

Why Am I Receiving Additional Bills?

Out-of-network providers may send you a bill for services that you did not realize you were receiving, or in a situation where you did not have a choice of provider. This may be the case if you visited a hospital emergency room, had blood or other laboratory specimens taken and sent to an out-of-network laboratory without your knowledge, or had surgery during which anesthesia was administered by an out-of-network anesthesiologist. Emergency room doctors and anesthesiologists are often “non-par,” meaning they elect not to participate in any insurance panels.

Since patients often do not get to choose their emergency doctor or anesthesiologist, this can result in unanticipated bills from these providers.

What Does the Law Say?

In New York State, there is a law that protects insured patients from surprise bills by out-of-network doctors who treat you at an in-network hospital or ambulatory surgery center. It also provides protections for unforeseen medical bills when patients are referred to out-of-network providers by an in-network provider. The law also protects all patients from bills for emergency services.

Basically the law says that under these circumstances, you will only be responsible for your in-network copayment, coinsurance or deductible, as long as you complete an Assignment of Benefits form allowing the provider to bill your insurance company, and send a copy of the form and the bill to both your insurer and provider. Uninsured patients also have protections under this law.

What Should I Do?

There are a few steps to take if you receive a surprise medical bill:

  1. Don’t panic, even if the bill is for a large amount.
  2. Make sure that you are reading a bill from a doctor, and not an Explanation of Benefits (EOB) from your insurance company. An EOB is not a bill and may not reflect the actual amount that you will be charged.
  3. If the bill is for services provided by an in-network physician, laboratory or other provider, call the provider and make sure that they have submitted the bill to your insurance company for payment. If it has been submitted, call your insurance company to find out if the bill will be covered.
  4. If the bill is for services provided by an in-network physician, laboratory or other provider, call the provider to request an Assignment of Benefits form. Complete the form and mail it along with a copy of the bill to both the provider and your insurance company.

Help is Available

While it is easy to become overwhelmed with exorbitant medical bills, there is help available. New York State offers resources, which you can access by calling (800) 342-3736 or emailing Surprisemedicalbills@dfs.ny.gov.

A Health Advocate may be your best resource for dealing with confusing medical bills, especially if you are managing a chronic illness or serious condition. Care Answered is happy to provide a free initial consultation to help you understand your situation. Just give us a call at (516) 584-2007 or email nicole@careanswered.com.

 

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