Knowledge Center

New York’s Emergency Medical Services and Surprise Bill Act was created to protect patients from unexpected charges when they receive emergency treatment from an out-of-network provider. The law applies when that care is delivered at a hospital or ambulatory surgical center that participates in the patient’s insurance network.

It also shields patients from surprise bills when a participating physician refers them to a nonparticipating provider without their knowledge or consent, a scenario that historically left patients caught between provider and payor.

When the Law Applies

Patients are covered under the New York Surprise Bill Law when they receive services from an out-of-network provider at an in-network hospital or ambulatory surgical center in any of the following situations:

1. No participating doctor was available.
2. An out-of-network provider rendered services without the patient’s awareness or written consent.
3. Unforeseen medical circumstances led to inadvertent out-of-network care.

These protections were designed to bring transparency and fairness to emergency and inadvertent billing—while still allowing providers to be compensated appropriately for the care they deliver.

Key Requirements and Provisions

The law includes several requirements that directly affect how out-of-network care is billed and reimbursed:

• No balance billing – Patients cannot be billed beyond their in-network cost-sharing obligations (deductible, copay, or coinsurance).
• Mandatory assignment of benefits – When patients sign an assignment of benefits form, they are only responsible for in-network cost-sharing on emergency or inpatient services.
• Prohibition on cost-sharing waivers – Out-of-network providers cannot waive or offer to waive a patient’s cost-sharing obligation to attract business.
• Full disclosure – Providers must disclose network participation status, billing codes, and estimated fees before scheduling any elective or non-emergency procedure.
• Arbitration (Independent Dispute Resolution) – If there is a payment dispute, either the provider or the payor may initiate binding arbitration through New York’s Independent Dispute Resolution process.

Each of these provisions aims to balance patient protection with provider rights, a system that demands diligence and precision from every independent surgeon practicing out of network.

How CHRMS Supports Independent Surgeons in New York

CHRMS works with independent surgeons across New York to ensure full compliance with the Emergency Medical Services and Surprise Bill Act while protecting rightful reimbursement. Our team tracks both State and Federal regulations, including the Federal No Surprises Act, effective January 2022, to help providers understand exactly which rules apply to each claim.

By combining legal understanding, billing expertise, and strategic negotiation, CHRMS empowers surgeons to manage these evolving requirements with confidence. We navigate the complexities so you can stay focused on patient care, not payer disputes.

Have questions about New York’s Surprise Bill Law or how it intersects with the Federal No Surprises Act? CHRMS can help you interpret the regulations, resolve disputes, and recover what you’ve earned.