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Provided by: Jennifer Kirschenbaum, Esq.
March 31, 2015
Question:
Jennifer,
Thank you for all of the excellent information on the Surprise Law. I watched the webinar, enjoyed the newsletters clarifying my patient disclosure requirements and purchased my OON forms. I just have a follow up question - I understand that since I do not take insurance and participating physicians refer to my office, I may be at risk of rendering a Surprise Bill to a patient, but believe this hinges on whether or not the participating physician made a "Referral" to me. Does that mean just by giving my name out or is there a formal referral process?
Appreciate clarification before the April 1 deadline.
Thanks,
Dr. P
Answer:
Dr. P, I am impressed! You have clearly done your homework by asking such an informed question. Yes, the definition of referral in this context matters and to answer, I draw directly from the Department of Financial Services website -
- Referral. A bill will also be a surprise bill if your patient is referred by a participating doctor to a non-participating provider and your patient did not sign a written consent acknowledging that the services would be out-of-network and would result in costs not covered by the patient's health plan. A referral occurs: (1) during the course of a visit with a participating doctor, a non-participating provider treats the patient; or (2) the patient's participating doctor takes a specimen from the patient in the office (for example, blood) and sends it to a non-participating laboratory or pathologist; or (3) for any other health care services when referrals are required under the patient's plan.
Evident from the DFS website, "referral" is defined with specificity, and whether a "surprise bill" is received by a patient does hinge on whether or not a "Referral" is made from a par to a non-par. So, when you do receive a "referred" patient, be sure to adhere to all disclosure requirements and have on file the patient's acknowledgement they may incur out of pocket expenses from a non-par provider. (Remember, the requirements discussed in our Surprise Law discussions apply to all licensed professionals that may receive a referral by a participating physician!)
Looking for more information on NY's Surprise Law? Visit th DFS website - http://www.dfs.ny.gov/consumer/hprotection.htm.
Protect your Practice from "Surprise Bill" disputes. CLICK HERE for OON Disclosure Forms. (All orders in March 2015 will be processed at the reduced fee of $315.)
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