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Dispute a Surprise Medical Bill or a Bill for Emergency Services
You can submit a dispute through the Independent Dispute Resolution (IDR) process for surprise bills or emergency services.
If You Have Health Insurance that New York Protections Apply To
If your health insurance ID card says “fully insured” or you are covered under the New York State Empire Plan or the New York State Student Employee Health Plan that is available to SUNY and CUNY graduate and teaching assistant employees, then you are protected from a surprise medical bill or a bill for emergency services under New York Law.
What to Do if You Get a Surprise Bill
A surprise medical 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 are only responsible for your in-network copayment, coinsurance, or deductible.
1. Sign a Surprise Medical Bill Certification Form
You MUST sign a Surprise Medical Bill Certification Form if your in-network doctor referred you to an out-of-network provider.
You SHOULD sign a Surprise Medical Bill Certification Form if an out-of-network provider treated you at an in-network hospital or ambulatory surgical facility. The Certification Form is not required for these services, but it is recommended.
2. Send the Form and a Copy of the Bill
Send the Surprise Medical Bill Certification Form to your health plan and your 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.
If You Have Employer/Union Self-Funded Coverage
The Federal No Surprises Act protects you from surprise medical bills from an out-of-network provider in an in-network hospital or ambulatory surgical center if your employer or union self-funds your coverage. (However, if you are covered under the New York State Empire Plan or the New York State Student Employee Health Plan that is available to SUNY and CUNY graduate and teaching assistant employees, the New York State surprise bill protections apply to you.)
You are only responsible for paying your in-network copayment, coinsurance, or deductible for a surprise bill.
For more information about the Federal consumer protections, visit the CMS No Surprises Act website.
If 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. You have to ask for the review within 120 calendar days of getting the bill. An independent reviewer will look at the good faith estimate, the bill, and information from the provider to decide the amount, if any, that you have to pay for each service. 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 mail it to:
New York State Department of Financial Services
Consumer Assistance Unit/IDR Process
One Commerce Plaza, Albany, NY 12257
If You Are an Insurer or a Provider with a Dispute
Providers and insurers submitting disputes involving surprise bills or bills for emergency services for a patient with fully insured coverage or a patient covered under the New York State Empire Plan or the New York State Student Plan must log onto the DFS portal to obtain a case number.
If it is your first time using the DFS Portal you will need to create a Portal account, then use the Ask for Apps tab to request access to the NY IDR application. Once you submit the IDR, you will receive an IDR case number:
To get started, visit the DFS Portal:
Once you have the case number:
- fill out the IDR Provider and Insurer Application AND
- send the application to the assigned Independent Dispute Resolution Entity (IDRE) along with the full IDR fee for the assigned IDRE.
Learn More
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]. Please make note of the date(s) of service for your inquiry as different laws and processes may apply depending on when you received the services.
Learn more about how to contact DFS on our Contact Us page.