We participate in Medicare, Workers’ compensation and No-fault insurance, and work with the out-of-network benefits of most other insurance companies, and our benefits expert can assist you with any questions you may have.

We have treated hundreds of patients with all types of insurance, including for surgical care. We take pride in our transparency and adherence to all the regulations. Please see below some information about your rights and protections.

Patient Rights & Protections

Your Rights and Protections Against Surprise Medical Bills

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.

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.

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

“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.

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 this link for information about your rights under federal law.

Workers Compensation

Workers compensation is a form of insurance that provides benefits to employees who suffer work-related injuries or illnesses. In New York, most employers are required to carry workers’ compensation coverage to ensure injured workers receive medical treatment and wage replacement benefits without needing to file a lawsuit.

A workplace injury can create a lot of not only about your health, but also about your income and ability to return to work. Workers’ compensation is designed to help employees receive medical care and financial support while they recover.

What Does Workers’ Compensation Cover?

Depending on your situation, workers compensation benefits may help pay for:

• Medical treatment related to your work injury
• Physical therapy and rehabilitation services
• A portion of lost wages if you’re unable to work
• Disability benefits for temporary or permanent injuries
• Ongoing medical care for lasting conditions

Claims are administered through the workers compensation insurance carrier and overseen by the New York State Workers Compensation Board. If an employer does not carry the required insurance, injured workers may still have access to benefits through state-administered programs, while the employer may face penalties.

Disability Benefits

Depending on the severity of the injury, benefits may be available for:

• Temporary Partial Disability: You can work but with restrictions or reduced earnings.
• Temporary Total Disability: You are temporarily unable to work.
• Permanent Partial Disability: You have a lasting impairment but can still work in some capacity.
• Permanent Total Disability: You are permanently unable to perform any work.

The amount of compensation depends on factors such as:

• Your average weekly wage before the injury
• The severity of the injury
• Medical findings and work restrictions
• Your ability to return to work

Medical Treatment

To support a workers compensation claim:

• Seek medical care immediately after your injury.
• Obtain treatment from healthcare providers authorized to treat workers compensation patients.
• Maintain proper medical documentation to support your claim and any disability benefits.

If Your Employer Does Not Have Insurance

New York provides protections for injured workers even when an employer fails to carry required workers compensation coverage. Employers who do not comply with insurance requirements could face significant penalties, so you should consult with a lawyer.

Conclusion

Workers’ compensation laws and benefits can be complex. While us medical providers can assist with treatment and medical documentation, injured workers should definitely consult qualified legal or insurance professionals regarding claim procedures, compensation amounts, and available benefits.

No Fault Insurance

Being involved in a car accident can be overwhelming. Even if the crash seems minor at first, injuries can develop over the hours or days that follow. Knowing what steps to take after an accident can help protect both your health and your rights.

After any car accident, getting evaluated by a medical professional should be a priority. Some injuries are immediately obvious, while others may not show symptoms right away.

A prompt medical evaluation can help identify injuries early, improve treatment outcomes, and create documentation of your condition. Medical records are often important when dealing with insurance claims or pursuing compensation for accident-related expenses.

Not all injuries appear immediately after a collision. It’s common for accident victims to feel relatively normal at first, only to develop symptoms days later.

Some delayed injuries and symptoms include:

• Persistent headaches
• Neck pain and stiffness
• Shoulder pain
• Back pain
• Numbness or tingling in the arms or legs
• Abdominal pain or discomfort
• Dizziness or difficulty concentrating

These symptoms can be associated with conditions such as whiplash, concussions, herniated discs, soft tissue injuries, or internal injuries. If you notice new symptoms after an accident, seek medical attention promptly.

When Might You Have a Legal Claim?

A legal claim may exist if another driver’s negligence caused the accident and resulted in your injuries.

Examples of negligent driving include:

• Driving under the influence of alcohol or drugs
• Distracted driving, including texting while driving
• Speeding
• Running red lights or stop signs
• Failing to yield the right of way
• Falling asleep behind the wheel

Determining fault is not always straightforward. In some cases, an investigation may be necessary to establish how the accident occurred and who was responsible.

Depending on the circumstances of the accident, available insurance coverage may help pay for medical expenses. In cases where another driver was responsible for the crash, additional compensation may be available for losses such as:

• Medical expenses
• Lost wages
• Reduced earning capacity
• Future medical treatment
• Pain and suffering

Every situation is different, so it’s important to understand your options and available coverage.

So what do I do?

Recovering from a car accident involves more than repairing a vehicle. Your health should come first! Seeking timely medical care, following your treatment plan, and understanding your legal and insurance options can make the recovery process smoother and help ensure you receive the care and support you need.

Our office can assist in handling all of these questions for you!

To schedule an appointment with one of our Fellowship trained surgeons, call (212) 951-0182, (516) 362-2777, (631) 981-2663. Our office staff will also help you clarify all your concerns regarding insurance coverage.