OMBUDSMAN ALERT: Just Say “NO” to Surprise Medical Bills!


obThe “Emergency Medical Services and Surprise Bills” Law passed in 2014 by New York State has the potential to save NY consumers from unfair and “surprise” bIlls for medical expenses and emergency services.

The main reason for writing this article is to inform our readers of the existence of this law and their need to ensure that its application to their personal medical expenses and/or emergency room services has been properly carried out. As your consumer advocate, this writer has recently learned that a number of Rockland residents, unaware of this law. Were receiving unfair and “surprise” bills for their personal medical expenses as well as for emergency room services.

In my careful reading of this law, it was clear that consumers covered by all NY state approved insurance plans will never have to pay more than their usual in-network cost sharing and/or co-payment regardless of the network status of their provider!

Furthermore, in this writer’s discussion with several Rockland residents who received these “surprise” medical bills-in some cases as much as seven months after their medical services-and were uncertain if they had to pay it to the out-of-network provider, I had them call their in-network provider who arranged to send them forms to appeal these unfounded charges. In at least one case a consumer actually paid nearly $700 to an out-of-network provider and will now try to recover $680 of this amount since he had a co-pay of only $20 with his in-network provider!

Although this writer is most happy to assist Rockland consumers in achieving the potential benefits of this most important law, it is unfortunate that the law permits these “surprise” bills to be generated and “forces” the consumer to “appeal” in order to pay the proper(often greatly reduced) medical bill!

For the above reason I contacted our three local legislators, Senator Carlucci, Assemblywoman Jaffee, and Assemblyman Zebrowski who ALL supported this VITAL bill. I also requested that they look into further legislation that would prevent the generation of these “surprise” bills, if possible.

This writer will end this article with quotes from each of these three fine legislators as follows:

Senator Carlucci:

“This is a great bipartisan bill to make sure people are not receiving multiple bills for procedures that are life-giving. This is an unnecessary problem and this law will help to address the issue. I am overjoyed that this law has been implemented and look forward to this measure protecting consumers from surprise medical bills”,

Assemblywoman Jaffee:

The Assembly fought hard for this bill, that is now law, to establish consumer protections, to prevent surprise medical bills, to ensure access to out-of-network coverage, and to prohibit excessive emergency charges. The changes that have come from this much needed legislation are intended to ensure that consumers who seek medical attention from an out-of-network provider will be properly informed of the charges that they man incur, and that in the event of a dispute over a bill for emergency services or a surprise bill between insurers and providers, consumers will be removed from that dispute and not have their claim fall subject to a long, protracted hearing process. Without these critical protections, too many New Yorkers faced excessive medical bills that they had no way to prevent and little power to negotiate”.

Assemblyman Zebrowski:

“We need to ensure access and affordability of healthcare and protect against predatory billing. it is hard enough for patients to guarantee that their doctor is in network and covered by insurance. During an emergency or within a hospital setting, it is impossible for a patient to verify that each and every service, or each and every medical assistant, technician, or other employee that may provide care is in network. This law sets up a process where patients can be assured that they will not be responsible for outrageous surprise charges.”

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