New York’s New “Surprise Bill” Law Rolls out New Health Insurance Protections for Consumers

The state legislature passed new consumer protections from “surprise bills”—medical bills to consumers that result from the unexpected use of out-of-network medical providers, or bills which impose far higher costs on consumers than they have reason to expect. Prior to the new law—which is effective April 1, 2015—insured individuals often complained about receiving inadequate reimbursement (or none at all) from their insurers for medical services that they received outside of a provider network. In many cases the patients were unaware that the medical services they were receiving were, in fact, out of network and thus more expensive. Many patients were not financially prepared to handle these additional costs. The problem was so common that these types of consumer complaints outnumbered all other complaints handled by the state’s health consumer assistance agencies, insurance regulators, and the state Attorney General’s Health Care Bureau. New York’s new “Surprise Bill” health insurance law requires that all health plans that are based on comprehensive provider networks (including PPO—preferred provider organization and EPO—exclusive provider organization plans) be certified as having provider networks that can meet the health needs of their members without having to rely on the more expensive out-of-network services.