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December 21, 2022

New York Implements New Provider Directory Requirement

The New York State Department of Financial Services issued a new patient protection regulation which would require an insurer to provide network status information to their members within one (1) business day of a member’s request. Similar to the provider directory requirements under the federal No Surprises Act, the regulation also prohibits an insured individual from being charged more than their in-network cost-share amount in the event the individual relied on incorrect network status information provided by the insurer. In such a situation, this regulation would also require the insurer to reimburse the provider for the out-of-network services regardless of whether the patient’s insurance includes coverage for out-of-network services. This regulation is yet another example of how both federal and state governments are working to eliminate those situations where patients receive surprise medical bills due to unforeseen circumstances which are outside of the patient’s control.

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