New York Laws
Article 6 - Emergency Medical Services and Surprise Bills
605 - Dispute Resolution for Emergency Services.

(3) The independent dispute resolution entity shall make a
determination within thirty business days of receipt of the dispute for
review.
(4) In determining a reasonable fee for the services rendered, an
independent dispute resolution entity shall select either the health
care plan's payment or the non-participating provider's fee. The
independent dispute resolution entity shall determine which amount to
select based upon the conditions and factors set forth in section six
hundred four of this article. If an independent dispute resolution
entity determines, based on the health care plan's payment and the
non-participating provider's fee, that a settlement between the health
care plan and non-participating provider is reasonably likely, or that
both the health care plan's payment and the non-participating provider's
fee represent unreasonable extremes, then the independent dispute
resolution entity may direct both parties to attempt a good faith
negotiation for settlement. The health care plan and non-participating
provider may be granted up to ten business days for this negotiation,
which shall run concurrently with the thirty business day period for
dispute resolution.
(b) Emergency services for a patient that is not an insured. (1) A
patient that is not an insured or the patient's physician may submit a
dispute regarding a fee for emergency services, including inpatient
services which follow an emergency room visit, for review to an
independent dispute resolution entity upon approval of the
superintendent.
(2) An independent dispute resolution entity shall determine a
reasonable fee for the services based upon the same conditions and
factors set forth in section six hundred four of this article.
(3) A patient that is not an insured shall not be required to pay the
physician's or hospital's fee in order to be eligible to submit the
dispute for review to an independent dispute resolution entity.
(c) The determination of an independent dispute resolution entity
shall be binding on the health care plan, provider and patient, and
shall be admissible in any court proceeding between the health care
plan, provider or patient, or in any administrative proceeding between
this state and the provider.
(d) For purposes of the hospital payment pursuant to subsection (a) of
this section, the amount the health care plan shall pay to the hospital
shall be at least twenty-five percent greater than the amount the health
care plan would have paid for the claim had the hospital been in
network, based on the most recent contract between the health care plan
and the hospital. Provided however, the amount paid by the health care
plan pursuant to this subsection shall not prejudice either party or
preclude either party from submitting a dispute to the dispute
resolution entity relating to the payment to the hospital or preclude
the hospital from seeking additional payment from the health care plan
prior to a decision by the dispute resolution entity. To the extent the
prior contract between the hospital and health care plan expired greater
than twelve months prior to the payment of the disputed claim, the
payment amount shall be adjusted based upon the medical consumer price
index. The provisions of this subsection shall only apply to the extent

the health care plan and hospital had previously entered into a
participating provider agreement.

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