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Post date: October 16 2015

A.G. Schneiderman Announces Agreements With NYC & Long Island Urgent Care Centers To Improve Disclosure Of Accepted Insurance Plans

First Enforcement Action Of New York’s Recent ‘Surprise Bill Law’ Will Protect Consumers, Reduce Costs For Patients

Schneiderman: As The Number Of Urgent Care Centers Continues To Increase, My Office Is Taking Steps To Ensure That These Centers Are Imparting Accurate Information About The Health Plans With Which They Participate. Consumers Need Accurate Information To Make Informed Health Care Decisions

NEW YORK – Attorney General Eric T. Schneiderman today announced agreements with four urgent care centers to provide clear, detailed information to consumers about the centers’ participation with health plans. This move, the first enforcement action of New York’s recently adopted ‘Surprise Bill Law,’ will protect consumers from unexpected medical billings and help patients make informed choices when selecting a provider.

In July 2015, the Attorney General issued letters to 20 urgent care centers requesting information about the centers’ representations on websites that they participate in a certain health plan networks.  The Attorney General was concerned that these centers’ website disclosures might have inaccurately disclosed their health plan network participation status.  As a result, consumers could receive unexpected bills from urgent care centers, when they believed that they would be responsible solely for their in-network co-payment or co-insurance obligation. 

New York’s “Surprise Bill Law,” which became effective March 31, 2015, requires, in part, that providers disclose in writing or through a website the health care plans in which the provider participates.  In addition, fee information must be made available to consumers. 

“At a time when many New Yorkers are feeling squeezed by rising health care costs, consumers deserve to know whether a provider is in-network or out-of network so that they know the costs before they choose a medical provider,” saidAttorney General Schneiderman. “I commend the pledge by these urgent care centers to adopt critical reforms.”

After review of the disclosures and underlying contracts, the Attorney General concluded that the information provided was at times unclear, incomplete, or not specific enough. The urgent centers that signed agreements are: 181st Street Urgent Care in Manhattan; Brookdale Urgent Care, affiliated with Brookdale Hospital; New York Doctor's Urgent Care with two locations in Manhattan; and Cure Urgent Care, with three locations in Manhattan and Long Island and adding more soon. 

The agreements require each center to strengthen disclosures and increase the instances of notification, including:

  • On its website, identify all health plans with which it has contracted to be an in-network participating provider.  If the center does not participate with all products that the health plan offers, it shall identify with specificity those insurance products for which it is an in-network, participating provider.
  • Post and provide the information in writing to the patient at the time of registration.
  • Cease using the term “works with” or “accepts” in relation to a health care plan.  Instead, the terms “in-network participating provider” or “out-of-network” will be used.  The centers shall also explain that “out-of-network” will lead to higher charges than in-network services.
  • Take steps to ensure the patient does not incur out-of-network costs if the required information is not communicated to the patient. 
  • Require all health care providers billing at the center to be an in-network participating provider with all health care plans with which the center contracts as an in-network participating provider.
  • Disclose to patients the availability of fee information, and, upon request, disclose to the patient the total cost for services that the center will bill the patient.

These agreements are part of the continuing work of the Attorney General to ensure health plans and health care providers clearly disclose critical information to consumers so that consumers can make the best choices for themselves and their families.  In 2011, for example, Attorney General Schneiderman settled with numerous health plans requiring them to publish accurate and up-to-date provider directories. The Attorney General’s Health Care Bureau has also entered into a number of settlements focused on ensuring accurate disclosures relating to health plan reimbursement, including settlements with AXA Equitable in 2012 and GHI in 2014.  The Health Care Bureau continues to work to make sure that consumers have information to make informed choices.  The Attorney General has also issued a consumer brochure about urgent care centers.

The Attorney General’s Health Care Bureau helps consumers navigate the complex health care system, challenges insurers who won’t cover provided service, and targets organizations that have fraudulent, misleading or deceptive business practices. Consumers who believe they may have been treated unfairly by a health care provider, HMO or insurance plan, should call the Attorney General’s Health Care Helpline at 800-428-9071.

The investigation of this matter was conducted by Assistant Attorney General Carol Hunt, of the Attorney General’s Health Care Bureau, which is led by Bureau Chief Lisa Landau. The Health Care Bureau is a part of the Social Justice Division, led by Executive Deputy Attorney General for Social Justice Alvin Bragg.

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