Health Plans And Hospital Affiliations By Doctor

Health Plans And Hospital Affiliations By Doctor

Page Updated:

Our physicians are contracted to be in-network providers with a variety of health plans. A full list of these plans and the physician’s respective hospital affiliations can be found here.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or hospital, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in a stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. If your insurance ID card says “fully insured coverage,” you can’t give written consent and give up your protections not to be balance billed for post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, and intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. If your insurance ID card says “fully insured coverage,” you can’t give up your protections for these other services if they are a surprise bill. Surprise bills are when you’re at an in-network hospital or ambulatory surgical facility and a participating doctor was not available, a non-participating doctor provided services without your knowledge, or unforeseen medical services were provided.

Services referred by your in-network doctor
If your insurance ID card says “fully insured coverage,” surprise bills include when your in-network doctor refers you to an out-of-network provider without your consent (including lab and pathology services). These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. You may need to sign a form (available on the Department of Financial Services’ website) for the full balance billing protection to apply.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have these protections:
You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

Generally, your health plan must:

  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed and your coverage is subject to New York law (“fully insured coverage”), contact the New York State Department of Financial Services at (800) 342-3736 or surprisemedicalbills@dfs.ny.gov. Visit http://www.dfs.ny.gov for information about your rights under state law.

Contact CMS at 1-800-985-3059 for self-funded coverage or coverage bought outside New York. Visit http://www.cms.gov/nosurprises/consumers for information about your rights under federal law.

For specific inquiries about your billing, please call (516) 629-3839.

The Doctors at New York Plastic Surgical Group have either authored or reviewed and approved this content.

QUESTIONS?

Contact Us

Virtual Appointments Available

*Checking this box is my consent to receive phone calls, text messages and emails about my healthcare from New York Plastic Surgical Group. I understand that this consent is not a condition of purchasing any goods or services, I can opt out at any time, message/data rates may apply, and opting-in includes acceptance of our Privacy Policy and Terms of Use. Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use.

View Our Locations

Mobile Map Image
NYPS Group LOCATIONS

Stamford

1290 Summer Street
Stamford CT, 06905

Driving Directions

NYPSG logo

Astoria 

30-16 30th Drive
NY, 11102

Driving Directions

NYPSG logo

Babylon

200 West Main Street
Babylon NY, 11702

Driving Directions

NYPSG logo

Brooklyn

86 Saint Felix Street
NY, 11217

Driving Directions

NYPSG logo

Brooklyn – Park Slope

330 9th Street
NY, 11215

Driving Directions

NYPSG logo

Connecticut

5520 Park Avenue
Trumbull CT, 06611

Driving Directions

NYPSG logo

East Hills

2200 Northern Boulevard
Greenvale NY, 11548

Driving Directions

NYPSG logo

Flushing

136-20 38th Avenue
NY, 11354

Driving Directions

NYPSG logo

Garden City

999 Franklin Avenue
Garden City NY, 11530

Driving Directions

NYPSG logo

Huntington

206 East Jericho Turnpike
Huntington Station NY, 11746

Driving Directions

NYPSG logo

Manhattan

5 Columbus Circle
New York NY, 10019

Driving Directions

NYPSG logo

Manhattan Uptown

1040 Park Avenue
New York NY, 10028

Driving Directions

NYPSG logo

Westchester

222 Westchester Avenue
Harrison NY, 10604

Driving Directions

NYPSG logo