How To Challenge a Surprise Medical Bill

A medical emergency that leads to an unexpected medical bill could force you to take out a loan or drain your bank account when your health insurance provider denies your claim. Fortunately, New Yorkers can fight back against surprise billing.

What Is a Surprise Medical Bill?

A surprise bill is for emergency treatment at a facility within your insurer’s network from a provider outside the network. You may also receive a surprise bill when your in-network provider arranges for an out-of-network provider to treat you without your consent. Out-of-network rates may also apply when an in-network provider is unavailable to offer treatment.

What Steps Should You Take After Receiving a Surprise Bill?

Challenging a surprise bill may seem daunting, but it can help you avoid crushing debt. You can start by contacting your health insurance provider to negotiate an assignment of benefits to your provider. Then, complete and forward the necessary paperwork to your insurance and healthcare providers to authorize claim payments directly to your provider. Federal and New York State surprise billing laws ensure you are only responsible for paying your insurance policy’s in-network fees.

Alternatively, you can apply to resolve the matter through New York State’s arbitration services for self-pay bills at least $400 more than your provider’s good faith estimate. Your provider may not send your invoice to a collections agency during an arbitration process and must stop action against accounts already in collections. Possible outcomes may include your bill’s recalculation, waiver or full payment.

Medical bills should not cripple your finances, and thanks to recent laws, there are more protections in place than ever before to ensure fair medical billing.