New York State Out-of-Network Surprise Medical Bill
You may not be responsible for a surprise bill for out-of-network services
A “Surprise Bill” is when you have insurance coverage issued in the State of NY:
Hospital or surgical centers: You are a patient at a participating
hospital or ambulatory surgical center and you receive services for
which:
- A network doctor was not available
- An out-of-network doctor provided without your knowledge
- Unforeseen medical circumstances arose at the time the
health care services were provided
It will not be a surprise bill if you chose to receive services from an
out-of-network doctor instead of form an available network doctor.
Referrals: Your network doctor did not ask your consent to refer
you to an out-of-network doctor, lab or other health care provider,
and did not tell you it would result in costs not covered by your
health plan.
An independent dispute resolution entity (IDRE) can determine if
you need to pay the bill. You, the plan or your doctor may request
an independent dispute resolution (IDR) for surprise bills and
referrals. Use the form on the next page to submit your request.
You do not have to pay the bill in order to be eligible to submit the
dispute for review to an IDRE.