New Law: Insurance Companies Will Have to Honor Their Mistaken Claims That a Medical Provider Is In-Network
A new law in New York State mandates that, when an insurance company informs the consumer that the provider is in-network, yet it is not, the insurance company will be prohibited from charging anything beyond what would be charged, had the provider been in-network.
The new law was prompted by many patients being hit with surprise bills after the services were rendered. Without notice, consumers were told after the fact that the provider delivering the service was not pre-approved by the insurer.
This new law passed down from Albany comes after the federal “No Surprise Act,” which took effect earlier in 2022 and prohibited providers from issuing bills to insured patients for out-of-network services at rates significantly higher than in-network rates. These bait-and-switches were especially prevalent in cases of emergency care, or where the procedure was initially at an in-network facility, but care was delivered by an out-of-network doctor.
This is a long-overdue regulation that will avoid many unaware patients from being saddled with bills that can amount to the tens of thousands of dollars.