DFS Issues Guidance On Surprise Billing Disputes

Accident and health (A&H) insurers and health maintenance organizations (HMOs) doing business in New York should consider new guidance from the New York Department of Financial Services on the independent dispute resolution (IDR) process for determining reasonable fees in the context of emergency services or "surprise billing."

Specifically, Circular Letter 2023-2, issued on May 9, 2023, addresses the criteria to be used to determine a reasonable fee in an IDR context and reminds issuers and providers that they must submit all relevant information to the IDR entity at the time of application or upon the IDR entity's request.

By way of background, Article 6 of the Financial Services Law establishes an IDR process for out-of-network emergency services in hospital facilities, for surprise bills in participating hospitals and participating ambulatory surgical centers, and for out-of-network services when a patient is referred by a participating physician. The IDR