New York’s Efforts to Reform Surprise Medical Billing

In 2014, New York State was the first state to enact surprise bill legislation. Following New York’s lead, 24 other states now have some form of surprise bill protections; of these, only 9 states, including New York, are found to have comprehensive protections for consumers. A surprise bill generally refers to an insured patient being charged for services inadvertently received by an out-of-network health care provider regardless of the patient’s knowledge of the physician’s network status. Surprise bills have recently been front-and-center at the national level: U.S. senators have introduced bills to address the problem, the Trump administration met with a group of patients to hear their personal stories and concerns, and the American College of Emergency Physicians has released its own framework to protect patients from this frustrating process.

This NYHealth issue brief provides details on New York’s groundbreaking surprise bill legislation, the impact of the law to date, and further enhancements that can be made to continue New York’s leadership on an issue that is increasingly receiving attention as a pro-consumer and pro-price transparency priority.

While much progress has been made at the State level, the brief offers further opportunities to build upon the success of New York’s law, including enhancing elements related to network adequacy standards and enforcement, network disclosure requirements, caps on provider billing, and expansion of the law to private companies.