New Law Targets Surprise Medical Bills

Staff Writer

A law included in the 2014-2015 State budget is looking to give patients a break on unexpected medical charges.

The new law will prevent surprise medical bills for patients sent by in-network doctors to out-of-network providers. These out-of-network medical services can be anything from a specialist to a specific lab for medical work that needs to be done.

According to New York State Superintendent of Financial Services Benjamin Lawsky, the law would end unexpected charges against patients who are referred out of their network by in-network providers. He added that complaints about these startling bills are the most common ones received by the Dept. of Financial Services, numbering between 2,000 and 3,000 annually.

Instead, beginning in 2015, surprise bills for out-of-network services will be resolved by the insurer and provider, rather than the patient. New York is now one of 13 states in the nation that have restrictions on out-of-network billing.

“This landmark legislation will provide critical protections for patients against the unwelcome surprise of a large out-of-network medical bill,” Gov. Andrew Cuomo said. “It holds consumers harmless by taking them out of the middle of those billing disputes, giving them greater peace of mind and economic security.”

The law came from sections of a bill introduced in the New York State Senate last year. One of that bill’s cosponsors, State Sen. Tony Avella (D-Bayside), said he was happy that it was included, but was concerned about a waiver available if the regulation creates an “undue hardship” on the insurer.

“I think the fact that we had part of this legislation included in the budget, which would set up a procedure in the insurance companies, is a good step forward. Unfortunately, also in the budget is a big loophole that allows the insurance companies to get away with that,” he said.

Beth Finkel, State Director for the American Association of Retired Persons, said that the budget law on preventing surprise medical bills was a good step, though there were some items left unresolved, like cost-effective help for family caregivers.

Reach Joe Marvilli at (718) 357-7400, Ext. 125,, or @Joey788.