N.Y. Announces Anti-Surprise Billing Regulation

The state of New York is enacting a regulation that will protect consumers from surprise medical bills when they relied on incorrect information from their insurance companies, Gov. Kathy Hochul announced yesterday, saying that she plans to include the proposal in her upcoming State of the State address.

The regulation, which addresses a longstanding concern from consumer advocacy groups, will allow consumers to pay no more than their in-network cost sharing amounts when they use providers who they believe are part of their network based on information provided to the consumers by the insurance companies.

The misinformation can be provided in the following ways:

  • A provider who does not participate in the insurer’s network is incorrectly listed as an in-network provider in the insurer’s online or hard copy provider directory;   
  • In response to a consumer’s request for information by telephone or through electronic means, an insurer indicates in writing that a provider is in-network when the provider is not in-network; or    
  • An insurer fails to provide network status information in writing to a consumer within a certain number of days of the consumer’s request for such information by telephone or through electronic means.    

“New Yorkers should never be blindsided by surprise costs due to incorrect information in their insurer’s healthcare provider directory,” Gov. Hochul said in a statement. “This new regulation will help protect consumers from surprise costs and ensure they pay no more than their in-network cost-sharing. This initiative is part of my administration’s commitment to ensuring consumers are treated fairly, and I’m proud that we are taking this action to deliver on that promise.”

A copy of the regulation can be accessed by clicking here.

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