Acting Superintendent Adrienne A. Harris today announced that the New York State Department of Financial Services (DFS) is proposing a new regulation to protect consumers against healthcare provider directory misinformation.  The proposed regulation will ensure that consumers who believe that a provider is in their network based on incorrect information provided by their insurer will pay no more than their in-network cost-sharing for services from that provider.

“Consumers should not be surprised by large out-of-network costs when they receive healthcare services from providers they believe are in-network based on incorrect information provided by their insurer,” said Acting Superintendent Harris. “This proposed regulation ensures New Yorkers have accurate and up-to-date information about which healthcare providers are in-network so that they can make healthcare decisions with more transparency.  This proposal will help consumers protect their financial health and well-being.”

The proposed regulation addresses a top concern for consumer advocacy groups by protecting consumers against out-of-network charges when a provider is incorrectly listed as in-network in the insurer’s provider directory, when an insurer provides incorrect information about a provider’s network participation status in response to a request from a consumer, or when an insurer fails to respond to a consumer’s request for such information.

The proposed regulation ensures that consumers pay no more than their in-network cost-sharing when they receive services from an out-of-network provider based on provider directory misinformation.

Under the proposed regulation, provider directory misinformation occurs when:    

• A provider who does not participate in the insurer’s network is incorrectly listed as an in-network provider in the insurer’s online or hard copy provider directory;  
• In response to a consumer’s request for information by telephone, an insurer indicates in writing that a provider is in-network when the provider is not in-network; or   
• An insurer fails to provide network status information in writing to a consumer within one business day of the consumer’s request for such information by telephone.  

The proposed regulation is consistent with the federal No Surprises Act requirements protecting consumers against provider directory misinformation, which will be effective in January 2022.   

A copy of the proposed regulation can be found on the DFS website.