New York – Emergency Medical Services and Surprise

The Emergency Medical Services and Surprise Bills Law (the "New Law"), which goes into effect March 31, 2015, increases protection of New York consumers from "surprise bills" received for medical services performed by certain non-participating (out-of-network) physicians. The New Law also provides protections to consumers from bills for emergency services.

The New Law is likely to have a significant impact on balance billing practices in New York, which is frequently a frontrunner in developing state-specific rules and regulations of the medical billing and revenue cycle management industries. "Balance billing" is the term commonly used to describe the practice of many healthcare providers who bill their patients for the difference between the amount a patient's insurer reimburses the provider and the amount the provider charged the patient for the medical services. A common expression of balance billing is a patient's receipt of emergency medical services from a provider outside the patient's network. Because of the patient's immediate need for medical attention, he or she is not afforded the luxury of ensuring the services are provided by an in-network provider. Later, when the insurer refuses to reimburse the out-of-network provider for the full amount of the emergency services, the patient is left holding the bag for a large, unforeseen medical bill.