What Is Surprise Medical Billing

What is surprise medical billing?

Surprise billing or unanticipated billing are terms being used to describe circumstances when a patient receives services from an out-of-network provider, at an in-network facility and is billed for those services. Surprise bills can be very costly for patients. For example, a patient goes into an emergency room at an in-network hospital and receives care from an out-of-network doctor. Later, the patient receives a costly bill for out-of-network care. But how did this happen? This happens when

1. you received services from a non-participation Physician at a participating hospital or ambulatory surgical center, where a participating physician was not available or
2. a non-participating physician provided services without your knowledge or
3. an unforeseen medical circumstance arose at the time the services were provided 
4. you were referred by a participating physician to a non-participating provider, but you did not sign a written consent that you knew the services would be out of network (which would result in the cost not being covered by the insurer) 

The good news is that there is a dispute resolution process. Complete the form on the link below.

 NY Surprise Medical Bills and Assignment form.pdf

Mail to:

Consolidated Health Plans
2077 Roosevelt Ave.
Springfield, MA 01104

           or 

Send the form electronically to: [email protected]

https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills