DFS Report Details New York’s Surprise Bill Law

September 23, 2019

The New York State Department of Financial Services (DFS) released a report last week detailing the State’s experience under its comprehensive, first-in-the-nation surprise bill law, which became effective in 2015. The report’s key findings are that:

  • The law has saved New York consumers more than $400 million
  • Out-of-network billing has declined by 34%
  • In-network emergency physician prices have decreased by 9%

The report also provides data on the law’s Independent Dispute Resolution (IDR) process, which allows insurers, providers, and consumers to challenge the amount to be paid for surprise bills under baseball-style arbitration. During the law’s initial four years, 2,595 disputes were reviewed under the IDR process, with the number increasing each year. Importantly, over time, the arbiters have increasingly ruled in favor of providers, meaning the provider’s charge was determined to be more reasonable than the plan’s initial payment. The chart below details the IDR results.

IDR Results 2015 2016 2017 2018
Dispute Resolution claims 149 491 807 1148
Ruled in favor of plan 37% 38% 31% 18%
Ruled in favor of provider 25% 15% 25% 34%
Split decision 15% 28% 22% 35%
Settlement 34% 19% 22% 12%

*Includes detail from DFS consumer reports

Overall, the report finds that New York’s law works well. This is especially important given the alternate models being considered in Washington, DC, which GNYHA believes would harm providers.