Surprise Bill and the UR Health Plans
March 30th, 2015 | ArchiveThe New York State Legislature approved the Emergency Services and Surprise Bills law, which goes into effect on March 31, 2015. The Surprise Bills law is designed to protect patients from “surprise bills” they may receive from out-of-network providers that render services without first informing the patient of the provider’s out of network status, and its provisions hold the patient harmless for certain out of network copays and/or cost-sharing. The Surprise Bills law applies to non-emergency services, and allows for an independent dispute resolution process for non-participating providers, health insurers, and non-insured patients.
There have been many questions from AHP providers about the Surprise Bills law and how it impacts referrals for patients covered by the University of Rochester’s health plans. Since AHP is that plan’s tier one network, UR health plan patients will have lower out of pocket expenses when referred to an AHP provider, and AHP members are encouraged to help UR Health Plan patients keep their expenses down by keeping referrals within AHP.
However, there may be occasions to refer UR health plan members to a tier two provider, which is any provider participating with the patient’s UR health plan third party administrator (Aetna or Excellus BCBS) but non-par with AHP. In those instances, the patients out of pocket costs may be higher, but those tier two providers are still considered “in-network” for the purposes of the Surprise Bills law, and no obligation to inform the patient applies. However, referrals to tier three providers (those that are neither par with AHP or Aetna/Excellus) would trigger a disclosure obligation under the Surprise Bills law.
Learn more about the provisions of the Emergency Services and Surprise Bills law by visiting www.mssny.org.
For questions about the Surprise Bills law and its implications for UR Health Plan patients, contact Jeanine Wilder at 585-758-0904 or [email protected].
