Using New York State Consumer Protections to Get Insurers to Pay Bills

The election has created change and uncertainty around national health care laws, making now a good time for New Yorkers to understand state-based laws that protect us as health care consumers. New York State law contains consumer protections that can help individuals have care paid for by their insurer, avoiding large unreimbursed bills incurred by providers. Demystifying these legal rights can save insureds — and their advocates — time, money, and frustration, allowing them to focus on their health, instead of the cost of health care.

New Yorkers who get their private health insurance from a plan that is covered by New York law, whether that plan comes from an employer or the Marketplace, have four crucial consumer protections:

• Transitional care laws allow individuals to continue receiving insurance coverage for seeing their doctor, even if that doctor is no longer covered by their insurance;
• Appealing denials of care and payment from insurance companies;
• Network adequacy protections requiring insurers to have enough providers of different types for their enrollees to access;
• Surprise Bill law protecting consumers from paying certain out-of-network bills.

Our associate, Alex Berke’s recently published article in the New York State Bar Association Health Law Journal, “Using Health Insurance Consumer Protections To Increase Reimbursements For Providers and Decrease Out-of-Pocket Costs For Consumers,” examines these laws in depth, including how using them wisely can get a bill paid.

Changes are undoubtedly coming for the health insurance market, but not all relevant laws are Federal, and as New Yorkers, we should use the consumer protections we have to get the best value for our health insurance dollars.