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Surprise Bill? "Referral" matters!

                                        Provided by:  Jennifer Kirschenbaum, Esq. 

                                                              March 31, 2015 

 

 

Question:

Jennifer,

Thank you for all of the excellent information on the Surprise Law. I watched the webinar, enjoyed the newsletters clarifying my patient disclosure requirements and purchased my OON forms. I just have a follow up question - I understand that since I do not take insurance and participating physicians refer to my office, I may be at risk of rendering a Surprise Bill to a patient, but believe this hinges on whether or not the participating physician made a "Referral" to me.  Does that mean just by giving my name out or is there a formal referral process?

Appreciate clarification before the April 1 deadline. 

Thanks, 
Dr. P

Answer:

Dr. P, I am impressed!  You have clearly done your homework by asking such an informed question.  Yes, the definition of referral in this context matters and to answer, I draw directly from the Department of Financial Services website

  • Referral. A bill will also be a surprise bill if your patient is referred by a participating doctor to a non-participating provider and your patient did not sign a written consent acknowledging that the services would be out-of-network and would result in costs not covered by the patient's health plan. A referral occurs: (1) during the course of a visit with a participating doctor, a non-participating provider treats the patient; or (2) the patient's participating doctor takes a specimen from the patient in the office (for example, blood) and sends it to a non-participating laboratory or pathologist; or (3) for any other health care services when referrals are required under the patient's plan.

Evident from the DFS website, "referral" is defined with specificity, and whether a "surprise bill" is received by a patient does hinge on whether or not a "Referral" is made from a par to a non-par. So, when you do receive a "referred" patient, be sure to adhere to all disclosure requirements and have on file the patient's acknowledgement they may incur out of pocket expenses from a non-par provider.  (Remember, the requirements discussed in our Surprise Law discussions apply to all licensed professionals that may receive a referral by a participating physician!) 

Looking for more information on NY's Surprise Law?  Visit th DFS website - http://www.dfs.ny.gov/consumer/hprotection.htm.
 
Protect your Practice from "Surprise Bill" disputesCLICK HERE for OON Disclosure Forms.   (All orders in March 2015 will be processed at the reduced fee of $315.)



  

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                                 Have a question or comment for Jennifer?
Contact Jennifer at Jennifer@Kirschenbaumesq.com or  at (516) 747-6700 x. 302.

 


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