N.Y.
Public Health Law Section 24
Disclosure
Mentioned in
Health Care Provider Rights and Responsibilities
NY State Dept. of Financial Services, August 16, 2023
“The Insurance Law and Public Health Law include important protections for health care providers…”
Bibliographic info
Your Rights as a Health Insurance Consumer
NY State Dept. of Financial Services, August 16, 2023
“You have many rights and protections if you have health insurance coverage through an HMO or insurer…”
Bibliographic info
1.
A health care professional, or a group practice of health care professionals, a diagnostic and treatment center or a health center defined under 42 U.S.C. § 254b on behalf of health care professionals rendering services at the group practice, diagnostic and treatment center or health center, shall disclose to patients or prospective patients in writing or through an internet website the health care plans in which the health care professional, group practice, diagnostic and treatment center or health center, is a participating provider and the hospitals with which the health care professional is affiliated prior to the provision of non-emergency services and verbally at the time an appointment is scheduled.2.
If a health care professional, or a group practice of health care professionals, a diagnostic and treatment center or a health center defined under 42 U.S.C. § 254b on behalf of health care professionals rendering services at the group practice, diagnostic and treatment center or health center, does not participate in the network of a patient’s or prospective patient’s health care plan, the health care professional, group practice, diagnostic and treatment center or health center, shall:(a)
prior to the provision of non-emergency services, inform a patient or prospective patient that the amount or estimated amount the health care professional will bill the patient for health care services is available upon request; and(b)
upon receipt of a request from a patient or prospective patient, disclose to the patient or prospective patient in writing the amount or estimated amount or, with respect to a health center, a schedule of fees provided under 42 U.S.C. § 254b(k)(3)(G)(i), that the health care professional, group practice, diagnostic and treatment center or health center, will bill the patient or prospective patient for health care services provided or anticipated to be provided to the patient or prospective patient absent unforeseen medical circumstances that may arise when the health care services are provided.3.
A health care professional who is a physician shall provide a patient or prospective patient with the name, practice name, mailing address, and telephone number of any health care provider scheduled to perform anesthesiology, laboratory, pathology, radiology or assistant surgeon services in connection with care to be provided in the physician’s office for the patient or coordinated or referred by the physician for the patient at the time of referral to or coordination of services with such provider.4.
A health care professional who is a physician shall, for a patient’s scheduled hospital admission or scheduled outpatient hospital services, provide a patient and the hospital with the name, practice name, mailing address and telephone number of any other physician whose services will be arranged by the physician and are scheduled at the time of the pre-admission testing, registration or admission at the time non-emergency services are scheduled; and information as to how to determine the healthcare plans in which the physician participates.5.
A hospital shall establish, update and make public through posting on the hospital’s website, to the extent required by federal guidelines, a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the federal social security act.6.
A hospital shall post on the hospital’s website:(a)
the health care plans in which the hospital is a participating provider;(b)
a statement that (i) physician services provided in the hospital are not included in the hospital’s charges;(ii)
physicians who provide services in the hospital may or may not participate with the same health care plans as the hospital, and;(iii)
the prospective patient should check with the physician arranging for the hospital services to determine the health care plans in which the physician participates;(c)
as applicable, the name, mailing address and telephone number of the physician groups that the hospital has contracted with to provide services including anesthesiology, pathology or radiology, and instructions how to contact these groups to determine the health care plan participation of the physicians in these groups; and(d)
as applicable, the name, mailing address, and telephone number of physicians employed by the hospital and whose services may be provided at the hospital, and the health care plans in which they participate.7.
In registration or admission materials provided in advance of non-emergency hospital services, a hospital shall:(a)
advise the patient or prospective patient to check with the physician arranging the hospital services to determine:(i)
the name, practice name, mailing address and telephone number of any other physician whose services will be arranged by the physician; and(ii)
whether the services of physicians who are employed or contracted by the hospital to provide services including anesthesiology, pathology and/or radiology are reasonably anticipated to be provided to the patient; and(b)
provide patients or prospective patients with information as to how to timely determine the health care plans participated in by physicians who are reasonably anticipated to provide services to the patient at the hospital, as determined by the physician arranging the patient’s hospital services, and who are employees of the hospital or contracted by the hospital to provide services including anesthesiology, radiology and/or pathology.8.
A health care professional, or a group practice of health care professionals, a diagnostic and treatment center or a health center defined under 42 U.S.C. § 254b on behalf of health care professionals rendering services at the group practice, diagnostic and treatment center or health center, and a hospital shall make publicly available, and if applicable, post on their public websites, and provide to individuals who are enrollees of health care plans, a one-page written notice, in clear and understandable language, containing information on the requirements and prohibitions under 42 U.S.C. §§ 300gg-131 and 300gg-132 and article six of the financial services law relating to prohibitions on balance billing for emergency services and surprise bills, and information on contacting appropriate state and federal agencies if an individual believes a health care provider has violated any requirement described in 42 U.S.C. §§ 300gg-131 and 300gg-132 or article six of the financial services law.9.
For purposes of this section:(a)
“Health care plan” means a health insurer including an insurer licensed to write accident and health insurance subject to article thirty-two of the insurance law; a corporation organized pursuant to article forty-three of the insurance law; a municipal cooperative health benefit plan certified pursuant to article forty-seven of the insurance law; a health maintenance organization certified pursuant to article 44 (Health Maintenance Organizations)article forty-four of this chapter; a student health plan established or maintained pursuant to Insurance Law § 1124 (Institutions of higher education exempt)section one thousand one hundred twenty-four of the insurance law or a self-funded employee welfare benefit plan.(b)
“Health care professional” means an appropriately licensed, registered or certified health care professional pursuant to title eight of the education law.(c)
“Hospital” means a general hospital as defined in subdivision ten of § 2801 (Definitions)section two thousand eight hundred one of this chapter.
Source:
Section 24 — Disclosure, https://www.nysenate.gov/legislation/laws/PBH/24 (updated Apr. 22, 2022; accessed Apr. 27, 2024).
