Dispute a Surprise Medical Bill

You can submit a dispute through the Independent Dispute Resolution (IDR) process for surprise bills or emergency services.


What To Do If You Receive a Surprise Bill Or A Bill For Emergency Services And You Have Health Insurance Coverage Subject To NY Law

If you have health insurance coverage that you or your employer bought in NY (your health insurance ID card says “fully insured”) you will be protected from a surprise bill or a bill for emergency services.

What to Do if You Get a Surprise Bill. A surprise bill is when an out-of-network provider treats you at an in-network hospital or ambulatory surgical center OR you are referred by an in-network doctor to an out-of-network provider. You will only be responsible for your in-network copayment, coinsurance or deductible:

1. Sign Surprise Bill Certification Form. You must sign a Surprise Bill Certification Form if:

  • Your in-network doctor referred you to an out-of-network provider; or
  • An out-of-network provider treated you at an in-network hospital or ambulatory surgical facility before January 1, 2022. The form is not required for services provided on or after January 1, 2022 at an in-network hospital or ambulatory surgical facility, but it is recommended
  • Surprise Bill Certification Form (PDF)
  • NOTE: The form will also be available in other languages (Bengali, Chinese, Haitian-Creole, Korean, Polish, Russian and Spanish) soon.

2. Send Form and Bill. Send the form to your health plan and provider and include a copy of the bill or bills you do not think you should pay.

What to Do if You Get a Bill for Emergency Services. If you get a bill for emergency services, contact your health plan. You are only responsible for your in-network copayment, coinsurance or deductible.


What To Do If You Receive a Surprise Bill Or A Bill For Emergency Services And You Have Employer/Union Self-Funded Coverage

The date you received services and the type of payment dispute involved will determine whether you are eligible to file an IDR through New York State or whether you are eligible for protections under the Federal No Surprises Act through CMS. If you are eligible under the Federal Process, you will not need to file an IDR through New York State.

To help you determine whether you need to file a payment dispute, visit Surprise Medical Bills.

Patients with employer or union self-funded coverage who are eligible to submit a dispute through New York State, must complete an IDR Patient Application and send it to:

New York State Department of Financial Services
Consumer Assistance Unit/IDR Process
One Commerce Plaza, Albany, NY 1225


What To Do If You Receive a Surprise Bill Or A Bill For Emergency Services And You Are Uninsured

To help you determine where your payment dispute should be filed, visit Surprise Medical Bills.

If you receive a good faith estimate of the expected charges from your provider and you are billed for an amount that is at least $400 more than the good faith estimate, you (or your authorized representative) may dispute the charges in the Federal patient-provider dispute resolution process.  For more information about good faith estimates, visit the CMS No Surprises Act website

If you receive services from a doctor at a hospital or ambulatory surgical center and you aren’t given all the required information about your care or you get a bill for emergency services that you think is excessive, you may submit a dispute through New York State.  Complete an IDR Patient Application and send it to:

New York State Department of Financial Services
Consumer Assistance Unit/IDR Process
One Commerce Plaza, Albany, NY 12257


Insurer and Provider Disputes for A Surprise Bill Or A Bill for Emergency Services

Providers or insurers submitting a dispute involving a surprise bill or a bill for emergency services for an insured patient must log onto the DFS portal to obtain a tracking number:

To learn more about surprise medical bills, visit our Health Insurance Resource Center section on Surprise Medical Bills.


Questions?

If you have questions or need help, call (800) 342-3736 or email [email protected]. Where applicable, please indicate the date(s) of service in your inquiry as different laws and processes may apply depending on when you received the services.