Last year, New York enacted a law targeting surprise billing from out-of-network claims. More often than not, preliminary data found insurers prevailed over providers in hundreds of conflicts the state's independent entity adjudicated, according to Crain's New York Business.
Here are five things to know:
1. The law has widely been hailed as a reasonable compromise that mitigates the problem of balance billing, which triggered thousands of patients to complain to the state Department of Financial Services.
2. The law requires new disclosures from insurers, hospitals and physicians to help patients avoid higher out-of-network bills.
3. The state Department of Health is conducting a statewide audit to check compliance at 50 hospitals to 60 hospitals each quarter.
4. Of 291 disputes over bills for emergency services, the state Department of Health deemed the amount health plans paid reasonable in 22 percent of those cases. Providers won 13 percent of the cases.
5. By specialty, plastic surgeons were involved in the largest number of disputes related to emergency services at 21 percent, followed by physicians in emergency medicine (19 percent), orthopedic surgeons (8 perecnt) and general surgeons (6 percent).