If you have a surprise medical bill that you did not expect to receive, contact your state insurance department or attorney general. You can also sometimes get help from nonprofit consumer assistance programs who specialize in helping patients to settle disputes.
In New York state, you can contact:
The New York State Department of Financial Services. You can visit their complaint page or call (800) 342-3736, Monday through Friday, 8:30 AM to 4:30 PM.
The New York Attorney General’s Health Care Bureau. Visit their web site or call 1-800-428-9071.
(Note: This web site primarily focuses on surprise medical bills in New York State. If you are in another state, visit the National Association of Insurance Commissioners web site to find your insurance commissioner. Or visit the National Association of Attorneys General to find contact information for your attorney general.)
Community Health Advocates. Community Health Advocates (CHA), a program of the Community Service Society, provides free, confidential individual counseling and educational community presentations to consumers, advocates and providers for more than 10 years on various health insurance options. We are made up of a network of 30 community-based organizations from around New York State that helps New Yorkers:
- get health care
- get health insurance and
- get the most out of it
People can seek help regardless of whether they are privately insured, publicly insured or uninsured. Since 1999, CHA has educated and helped more than 177,000 consumers with their health access and health insurance issues.
We can speak your language! English, Spanish, Korean, Russian, Polish, Chinese… we provide services in more than 170 languages. You can contact CHA online, by phone or by visiting one of our network organizations. Click here to find an organization near you that suits your needs. You can also contact us by calling our helpline at 1-888-614-5400
Fair Health. Fair Health operates a national web site that provides web information about Out-of-Network charges by CPT code, and helps you interpret bills that you may have received. You can also use the web site to compare rates for procedures, and find out how much your health plan may reimburse you if you see out-of-network providers.
In 2009, an investigation by then-New York State Attorney General Andrew Cuomo uncovered conflicts of interest in one system that health insurers used to calculate reimbursement for patients who received care from providers outside their plan’s network. As a result of this investigation, FAIR Health — an independent, not-for-profit corporation — was created to establish and maintain a new database that could be used to help insurers determine their reimbursement rates for out-of-network charges, and provide patients with a clear, unbiased explanation of the reimbursement process.
For more information visit: www.FairHealthConsumer.org or call the FAIR Health consumer information center at:
1-855-566-5871 (Monday – Friday 9 a.m. — 6 p.m. Eastern Time)
*Important note: The new New York State out-of-network consumer protections enacted into law on April 1, 2014 do not take effect until 2016, because it will take some time to write and implement the new rules for preventing surprise bills, communicate them to the health plans and providers, and establish the independent dispute resolution process.
However, the providers and health plans do know these changes are coming, so that should give them a strong incentive to provide good information and assistance for avoiding unnecessary out-of-network expenses.