March 10, 2015


I rely on your newsletter for my updates.  When are you going to tell me what I need to do to prepare for the Surprise Law that was passed and starts April 1, 2015?

Dr. L


Not interested in reading the below and just want me to send you the forms you need customized for your practice?  CLICK HERE for OON Disclosure Forms.  (All orders in March 2015 will be processed at the reduced fee of $315.)

Dr. L, I suppose it’s time.  I've been stalling wondering whether this Law would be delayed, but seems we’re on course for now for effectiveness as of April 1. 

For ease of reading sake, I am intentionally not addressing Emergency and Hospital requirements under the law, but can if there is an interest.  Email me to request.  Please be advised this law does not apply to services rendered under Workers Comp. 
For those unaware of NY’s Surprise Law’s existence, as of April 1, physicians are required to provide patients certain disclosures, as follows –
  • Notice of health care plans you participate with (in writing or on website);
  • Hospital affiliations (prior to the provision of non-emergency services and verbally at the time an appointment is scheduled);
  • Amount or estimated amount of bill is available upon request;
  • Notice that your fee schedule is available upon request (in writing);
  • The name, practice name, mailing address, and telephone number of any healthcare provider scheduled to perform anesthesiology, laboratory, pathology, radiology or assistant surgeon services provided in the physician’s office or referred by the physician at the time of the referral or coordination of services;
  • The name, practice name, mailing address, and telephone number of any other physician whose services you will arrange and schedule at the time of any pre-admission testing, registration or admission at the time non-emergency services are scheduled for a patient’s scheduled hospital admission or scheduled outpatient hospital services
NY CLS Pub Health Law s. 24

In addition, an out of network provider is required to provide patients with a claim form for a third party payor with a patient bill for services, other than a bill for the patient’s co-payment, coinsurance or deductible. 

NY CLS Pub Health Law s. 23
In its impact statement, the Department of Finance highlights its position that the law will not impose any reporting, recordkeeping, or other compliance requirements on small businesses or local governments. The regulation only implements the Independent Dispute Resolution process for bills for emergency services and surprise bills.
The goal of the law is to stop “Surprise bills", which are defined by statute as a bill for health care services received by an insured for services rendered: (1) by an out of network provider at a participating hospital or ASC where a participating physician was not available or the out of network provider rendered services without the insured’s knowledge, or unforeseen medical services arise at the time the health care services are rendered, except where insured elects out of network provider; (2) where patient has not given explicit written consent acknowledging they were referred to an out of network provider, and that the referral may result in costs not covered by their health care plan; or (3) when an uninsured patient is not provided required disclosures and is treated at a hospital or ASC.  

NY CLS Financial Services  Law s. 603
Tune in Thursday to learn what happens when a Surprise Bill is rendered…
CLICK HERE for OON Disclosure Forms.   

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