Your Protections for Out-of-Network Emergency Services and Surprise Bills

Effective for services received on or after March 31, 2015, EmblemHealth has set up new protections to ensure that — in the following circumstances — members of EmblemHealth insured plans1 won't be responsible for costs other than the in-network cost-sharing (in-network copay, coinsurance and/or deductible) that applies under your plan. These two cases are:

  • If you receive out-of-network emergency services in a hospital
  • If you receive a non-emergency "surprise bill" for out-of-network services

This page describes these protections, which are effective with dates of service on or after March 31, 2015. It also explains what to do if you feel you have received a surprise bill.

1Please note that the emergency services and surprise bills protections described do not apply to you if your plan does not include a provider network feature. Some or all of these protections may also not apply to you if you are covered under any of the following types of plans or circumstances:

  • Self-insured group health plan;
  • Medicare supplement plan;
  • Medicare Advantage plan;
  • Medicaid Managed Care plan;
  • Medicare is your primary coverage (e.g. group health plan retiree benefits that supplement Medicare payments); or
  • Other plans and circumstances as may be determined by New York law and regulations and/or the New York State Department of Financial Services.

You will not be responsible for the costs of "emergency services" you receive in a hospital, other than any in-network cost-sharing (in-network copay, coinsurance and/or deductible) that applies to such services under your plan. This is true even if:

  • You receive the emergency services at an out-of-network hospital, or
  • An out-of-network doctor provides you services during an emergency hospital visit.

What are emergency services?

Emergency services generally refer to the following hospital services to treat an emergency condition:

  • Medical screening exams that a hospital's emergency department can perform, including ancillary services routinely used to assess emergency medical conditions, and
  • Additional medical exams and treatment required to stabilize a patient.

    An emergency condition means a medical or behavioral condition that produces symptoms serious enough to qualify it as an emergency condition. An example is if you have severe pain that you know could result in one or more of the following without getting immediate medical attention:

  • Extreme danger to the health of the person experiencing the emergency condition, or a behavioral condition
  • Serious impairment to the bodily functions of the affected person
  • Serious dysfunction of any bodily organ or part of the affected person
  • Serious disfigurement of the affected person

What are some examples?

Here are examples of times you would be responsible only for the in-network cost-sharing for out-of-network emergency services:

  • You go to an in-network hospital emergency department and an out-of-network doctor is brought in to perform services to treat the emergency condition
  • An ambulance takes you to an out-of-network hospital and you receive emergency services at that out-of-network hospital

Here are examples of times these protections would not apply:*

  • You receive services from a doctor at an out-of-network urgent care center, rather than in a hospital
  • You receive services in a hospital that do not qualify as emergency services, according to the above definition of emergency services

    * If your plan includes out-of-network benefits (usually called a PPO or POS plan), we would process the claim for out-of-network services according to the terms and conditions that generally apply to out-of-network benefits for the services you receive. These benefits usually involve higher cost-sharing and higher out-of-pocket costs than for in-network services. We have calculators to help you estimate how much you might pay for an out-of-network service under your plan — see the section "Estimating Out-of-Network Care Costs" for more information.

How does EmblemHealth process claims for out-of-network emergency services?

If EmblemHealth gets a claim for emergency services from an out-of-network doctor, we'll pay the claim at the amount we determine to be reasonable for the emergency services — except for any in-network cost-sharing (in-network copay, coinsurance and/or deductible) that applies under your plan.

If we pay an amount less than what the out-of-network doctor charges, EmblemHealth will send you a notice — either within, or together with, your Explanation of Benefits — explaining that:

  • Your out-of-pocket costs for the emergency services won't be any higher than if you'd received them from an in-network doctor,
  • Your cost-sharing for the emergency services may increase if an IDRE (independent dispute resolution entity) decides EmblemHealth must pay an additional amount(s) for the services, and
  • You should contact EmblemHealth if the out-of-network doctor bills you for the out-of-network emergency services for amounts greater than your in-network cost-sharing for the services. For instructions, scroll down to "What to Do If You Get a Bill for Out-of-Network Emergency Services or Surprise Bills."

You will not be responsible for the costs of "surprise bills" for out-of-network services, other than any in-network cost-sharing (in-network copay, coinsurance and/or deductible) that applies under your plan.

What's a "surprise bill"? What are some examples?

Not all out-of-network services are surprise bills. A surprise bill is a bill for covered non-emergency health care services rendered on or after March 31, 2015, where one of the following situations applies:

1)    You receive covered health services from an out-of-network doctor at an in-network hospital or ambulatory surgical center, in any one of the following circumstances:

  • An in-network doctor is unavailable

Example 1: You are not told that the scheduled in-network surgeon stepped out of the procedure and an out-of-network surgeon stepped in.

Example 2: An out-of-network anesthesiologist performs services during your surgical procedure without your knowing of the anesthesiologist's out-of-network status.

  • An out-of-network doctor delivers services and you didn't know that doctor was out of network

Example 1: You receive covered health services at an in-network ambulatory surgical center, and during that visit an out-of-network anesthesiologist provides services to you, without your knowing of that doctor's out-of-network status.

Example 2: An in-network ambulatory surgical center sends your lab specimen to an out-of-network lab or pathologist.

  • You need unexpected medical services while receiving other services

Example: Unexpected medical needs arise and an out-of-network surgeon is brought in to perform the unexpected services.

If a network provider was available and you elected to receive services from a non-participating doctor anyway, then it is not a surprise bill.


2)    An in-network doctor referred you to an out-of-network doctor, and you received covered health services without written consent acknowledging that you:

  • Knew that you are being referred to an out-of-network provider, and
  • Knew that getting services from that out-of-network provider could result in costs not covered by EmblemHealth.

Example 1: You receive covered health services in an in-network doctor's office, and during that visit an out-of-network provider provides services to you, without your written consent that you know of that provider's out-of-network status and that you may incur non-covered costs.

Example 2: An in-network doctor sends your lab specimen taken during an in-network office visit to an out-of-network lab or pathologist, without your written consent that you know of that provider's out-of-network status and that you may incur non-covered costs.


3)    An uninsured individual receives health services from a doctor at a hospital or ambulatory surgical center, where the health care provider did not give the individual certain required information.

How does EmblemHealth process claims for non-emergency surprise bills?

If EmblemHealth gets a claim for out-of-network services that seem to be related to a surprise bill, but that isn't submitted with a completed surprise bill Assignment of Benefits Form, EmblemHealth will send you a notice — either within, or together with, your Explanation of Benefits — explaining that the claim could be a surprise bill, and that you should contact EmblemHealth or refer to this web page for instructions on what to do next.

If EmblemHealth gets a claim for out-of-network services along with a completed surprise bill Assignment of Benefits Form, or a claim that we determine is a surprise bill without also receiving a surprise bill Assignment of Benefits Form, we will send you a notice explaining that:

  • Your out-of-pocket costs for the services related to the surprise bill won't be any higher than if you'd received them from an in-network doctor,
  • Your cost-sharing for the services may increase if an IDRE (independent dispute resolution entity) decides that EmblemHealth must pay an additional amount(s) to the provider for the services, and
  • You should contact EmblemHealth if the out-of-network doctor bills you for the out-of-network service.

What if EmblemHealth doesn't know a claim should be handled as a surprise bill?

In some cases, it may not be clear to EmblemHealth that a claim relates to a surprise bill. In such cases, we may deny the claim if you have only in-network coverage, such as HMO or EPO coverage.

If your plan includes out-of-network benefits (usually called a PPO or POS plan), we will process the claim according to the terms and conditions that normally apply to out-of-network services — which usually involve higher cost-sharing and higher out-of-pocket costs than for covered in-network services.

If you feel EmblemHealth should have processed a claim as a surprise bill, you should complete a surprise bill Assignment of Benefits Form and submit it to EmblemHealth. You also have the option to dispute our decision on the claim by filing a grievance.

For the address and other contact options for submitting forms, and for instructions on filing a grievance, see the section on this page "Disputing Claims for Out-of-Network Emergency Services or Surprise Bills."

If a doctor sends you a bill for out-of-network emergency services or you receive a surprise bill for out-of-network services, the out-of-network doctor must also provide you with a claim form and, if it's a surprise bill, the out-of-network doctor must provide you with a surprise bill Assignment of Benefits Form as well.

If you "assign benefits" for a surprise bill in writing to an out-of-network provider who knows you're insured under a health care plan, that provider cannot seek payment from you — except for any in-network cost-sharing (in-network copayment, coinsurance and/or deductible) that applies to the service under the terms of your plan.

If you receive a surprise bill for out-of-network services and you want to assign benefits, send EmblemHealth the following documents (by mail or email). Upon receiving this information, we will process a claim for the related services. Submit the following:

  1. Standard Assignment of Benefits Form (only surprise bills)
  2. Claim form
  3. Copy of the bill
 Contact Information: Your Options for Submitting Documents
Plan Type (Check Your ID Card) By Mail By Email
 HMO EmblemHealth
Claims Dept.
PO Box 2845
New York, NY 10116-2845
HMOEmblemHealthClaim@
emblemhealth.com
 PPO EmblemHealth
Correspondence Dept.
PO Box 2857
New York, NY 10116-2857
PPOEmblemHealthClaim@
emblemhealth.com

If you disagree with how we processed a claim because you believe the bill was for out-of-network emergency services or a surprise bill, you can do either or both of the following:

  • Call EmblemHealth Customer Service and tell us you think your claim was for emergency services or is a surprise bill. Please call the Customer Service phone number on the back of your member ID card. For a surprise bill, EmblemHealth may require you to complete and submit the standard surprise bill Assignment of Benefits Form, plus a copy of your Explanation of Benefits (EOB). For a surprise bill, you can also simply complete and submit the standard surprise bill Assignment of Benefits Form to EmblemHealth without calling and we will re-evaluate your claim. To submit the information noted in this paragraph, please refer to the chart immediately below.

    Contact Information: Member Correspondence for a Surprise Bill
     Plan Type
    (Check Your ID Card)
    By Mail In Person
     HMO EmblemHealth
    Claims Dept.
    PO Box 2845
    New York, NY 10116-2845



    EmblemHealth
    55 Water Street
    New York, NY 10041
     PPO EmblemHealth
    Correspondence Dept.
    PO Box 2857
    New York, NY 10116-2857


  • Submit a dispute by mail, in person or by fax (see chart below for contact information). Include with your submission a copy of your EOB for the service and for surprise bills, a completed standard Assignment of Benefits Form.


Contact Information: Disputing a Claim (Grievance & Appeals)
 Plan Type
(Check Your ID Card)
By Mail In Person  By Fax
 HMO EmblemHealth
Grievance and Appeal Dept.
PO Box 2844
New York, NY 10116-2844
EmblemHealth
55 Water Street
New York, NY 10041
 1-212-510-5320
 PPO EmblemHealth
Grievance and Appeal Dept.
PO Box 2844
New York, NY 10116-2844
EmblemHealth
441 Ninth Avenue
New York, NY 10001
 1-212-510-5320

If EmblemHealth reimburses an out-of-network doctor for an emergency service or surprise bill with an amount he or she determines to be unreasonable, or if EmblemHealth and the provider cannot otherwise agree on an appropriate payment for the service, the doctor or EmblemHealth may submit the dispute to an independent dispute resolution (IDR) process through the New York State Department of Financial Services.

Members covered under self-insured plans and individuals who do not have insurance may also access the IDR process in some circumstances.

The following describes how out-of-network doctors should proceed to submit a dispute through the IDR process for emergency services or surprise bills:

  • Health care providers for disputes with a health plan involving an insured patient. To submit a dispute, health care providers must:
  • Uninsured patients or patients with employer or union self-insured coverage, or insured patients who do not assign benefits for surprise bills. To submit a dispute, patients must complete this application and send it to NYS Department of Financial Services, Consumer Assistance Unit/IDR Process, One Commerce Plaza, Albany, NY 12257.

EmblemHealth has Cost Calculators you can use to estimate your out-of-pocket costs for specific services from an out-of-network doctor. You can access these calculators through your secure online member account, myEmblemHealth. To get started, sign in to or register for your account.

Which Calculator Should You Use?

It depends whether the doctor is inside or outside the provider network for your health plan.

  • Seeing an in-network doctor? Use the Treatment Cost Calculator.
  • Seeing an out-of-network doctor? Use the Fair Health Calculator.

How to Find In-Network Doctors

Use our Find a Doctor tool or call the Customer Service number on the back of your member ID card. Be sure to confirm the doctor participates in your plan’s provider network by asking the doctor’s office when making an appointment.

Different Processes for Different Plan Types

The steps for calculating costs may differ depending on your plan type. The “Cost Calculator” section of your secure online member account will guide you through the process you should follow based on your plan type. Please note the following, which may affect your costs:

  • HMO and EPO plans: If you have an HMO or EPO plan, then your plan generally does not cover out-of-network benefits, except for emergency services.
  • PPO and POS plans: If you have a PPO or POS plan, then your plan generally does provide benefits for most covered services received from out-of-network providers. The terms and conditions of out-of-network coverage vary depending on the specific plan you have.

To start using the Calculators, sign in to or register for your secure online member account and go to “Cost Calculators.”

Note: The EmblemHealth allowance will generally not reflect any applicable cost-sharing (i.e., copayment, deductible and/or coinsurance), which you must also pay toward the service(s) and will reduce the amount of the allowance actually payable by EmblemHealth. See your member contract or certificate of coverage for the cost-sharing that applies under your plan. Benefits will be subject to all terms, conditions, limitations and exclusions set forth in your plan. Benefit estimates from the calculators are not a guarantee. The actual payment will depend on a number of factors, including, for example, the services you receive, the amount billed by your doctor or other provider, the actual procedure codes submitted and your eligibility for benefits at the time you receive services.

Allowance: What a plan will pay for covered out-of-network services before cost-sharing is applied.

Cost-Sharing: The portion of the plan's schedule or allowance that plan members pay to use covered health services. There are three possible types of cost-sharing: copay, coinsurance and deductible. The amount of these costs depends on your specific health plan. For out-of-network benefits, cost-sharing does not include the difference between the EmblemHealth allowance and the provider's charges, which you are also responsible to pay (in addition to cost-sharing).

Explanation of Benefits (EOB): A summary of our payment decision(s) relating to a claim for health care services.

In-Network Provider: A doctor or other health care provider, or a health care facility, that participates in your health plan's provider network.

Network: Group of doctors, hospitals and other health care providers with whom a health insurer contracts to deliver medical services to its plan members.

Out-of-Network Provider: A doctor or other health care provider, or a health care facility, who does not participate in your health plan's provider network.

Out-of-Network Emergency Services

How are “emergency services” defined?

Emergency services generally refer to the following services provided to treat an emergency condition:

  1. Medical screening exams that a hospital’s emergency department can perform, including ancillary services routinely used to assess emergency medical conditions, and
  2. Additional medical exams and treatment required to stabilize a patient.

An emergency condition means a medical or behavioral condition that produces symptoms serious enough to qualify it as an emergency condition. An example is if you have severe pain that you know could result in one or more of the following without getting immediate medical attention:

  • Extreme danger to the health of the person experiencing the emergency condition, or a behavioral condition
  • Serious impairment to the bodily functions of the affected person
  • Serious dysfunction of any bodily organ or part of the affected person
  • Serious disfigurement of the affected person

Do the emergency services protections apply to my EmblemHealth plan?

The emergency services protections described apply to EmblemHealth insured plan members whose plans include a provider network feature. Some or all of these protections may also not apply to you if you are covered under any of the following types of plans or circumstances:

  • Self-insured group health plan;
  • Medicare supplement plan;
  • Medicare Advantage plan;
  • Medicaid Managed Care plan;
  • Medicare is your primary coverage (e.g. group health plan retiree benefits that supplement Medicare payments); or
  • Other plans and circumstances as may be determined by New York law and regulations and/or the New York State Department of Financial Services.

Do the emergency services protections apply to emergency services I receive at an out-of-network urgent care center?

No. To be eligible for these protections, emergency services must be received in a hospital.

An ambulance took me to an in-network hospital. Without knowing it, I received emergency services from an out-of-network doctor at that hospital. Am I responsible for the costs?

Since this was an emergency, you’re only responsible for paying your in-network cost-sharing (in-network copay, coinsurance and/or deductible) for the ambulance ride, the hospital visit and for the care you received from the out-of-network doctor.

How does EmblemHealth process claims for out-of-network emergency services?

If EmblemHealth gets a claim for emergency services from an out-of-network doctor, we’ll pay the claim at the amount we determine to be reasonable for the emergency services — except for any in-network cost-sharing (in-network copay, coinsurance and/or deductible) that applies under your plan.

If we pay an amount less than what the out-of-network doctor charges, EmblemHealth will send you a notice — either within, or together with, your Explanation of Benefits — explaining that:

  • Your out-of-pocket costs for the emergency services won’t be any higher than if you’d received them from an in-network doctor,
  • Your cost-sharing for the emergency services may increase if an IDRE (independent dispute resolution entity) decides EmblemHealth must pay an additional amount(s) for the services, and
  • You should contact EmblemHealth if the out-of-network doctor bills you for the out-of-network emergency services except for your in-network cost-sharing amount. For instructions, see the section “What to Do If You Get a Bill for Out-of-Network Emergency Services or Surprise Bills” on our dedicated web page.

We will also inform the out-of-network doctor how to initiate the independent dispute resolution process in the event the doctor is unsatisfied with our payment.

Non-Emergency Surprise Bills

What’s a "surprise bill"?

A surprise bill is a bill for covered non-emergency health care services, where one of the following situations applies:

  1. You receive covered health services from an out-of-network doctor at an in-network hospital or ambulatory surgical center, where either:

    • An in-network doctor is unavailable
    • An out-of-network doctor delivers services without your knowledge
    • You need unexpected medical services while receiving other services

    If you received the health care services when a network physician was available and you elected to obtain services from the out-of-network physician anyway, it is not a surprise bill.

  2. An in-network doctor referred you to an out-of-network provider, and you received covered health services from the out-of-network provider without your written consent acknowledging that you:

    • Knew the referred provider was outside your plan’s provider network, and
    • Knew that getting services from that out-of-network provider could result in costs not covered by EmblemHealth.

    A referral to an out-of-network provider occurs when:

    • Health care services are performed by an out-of-network provider in the network physician’s office or practice during the course of the same visit,
    • The network physician sends a specimen taken from the patient in the network physician’s office to an out-of-network laboratory or pathologist, or
    • For any other health care services performed by an out-of-network provider, when referrals are required under your health plan contract or certificate of coverage.
  3. An uninsured individual receives health services from a doctor at a hospital or ambulatory surgical center, where the provider did not share required information with a patient in a certain time frame.

Do the surprise bills protections apply to my EmblemHealth plan?

The surprise bills protections described apply to EmblemHealth insured plan members whose plans include a provider network feature. Some or all of these protections may also not apply to you if you are covered under any of the following types of plans or circumstances:

  • Self-insured group health plan;
  • Medicare supplement plan;
  • Medicare Advantage plan;
  • Medicaid Managed Care plan;
  • Medicare is your primary coverage (e.g. group health plan retiree benefits that supplement Medicare payments); or
  • Other plans and circumstances as may be determined by New York law and regulations and/or the New York State Department of Financial Services.


How do I know if a bill is a surprise bill?

Read about surprise bills on our dedicated web page, including the information under the sections “Non-Emergency Surprise Bills” and “What to Do If You Get a Bill for Out-of-Network Emergency Services or a Surprise Bill.” If you still have questions, you can call us at the number on the back of your member ID card.

Do these protections apply to services I choose to receive from an out-of-network doctor?

Generally, no. If you knowingly opt to receive non-emergency services from an out-of-network provider rather than from in-network providers, the protections do not apply and you will be responsible for paying for the services of the out-of-network provider.

If your plan includes out-of-network benefits (usually called a PPO or POS plan), you generally will have benefits for most covered services even if you receive them out-of-network, but the cost-sharing and out-of-pocket expenses will generally be higher than if you had obtained services in-network. Be sure to check whether your plan has out-of-network benefits, and please review your contract or certificate of coverage for the terms and conditions of your out-of-network coverage.

I chose to see a doctor who it turns out is not in my plan’s provider network. Do the protections apply?

Generally, no. In most cases, you are responsible for all costs of bills for covered services you choose to receive from doctors who are not in your plan’s provider network. So, before seeing a doctor, be sure to confirm the doctor participates in your plan’s provider network by checking the online provider directory, asking the doctor’s office when making an appointment, or calling EmblemHealth to ask.

If your EmblemHealth plan covers out-of-network services (usually called a PPO or POS plan), the out-of-network services may be eligible for coverage, according to the terms of your plan’s coverage for out-of-network services, though usually at higher cost-sharing and with more out-of-pocket costs than in-network services.

During my non-emergency surgery at an in-network hospital or surgical center, an out-of-network doctor stepped in to perform services without my knowing it. Am I responsible for the costs?

Since you didn’t know you were getting out-of-network care, the protections apply and you are not responsible for any costs other than any applicable in-network cost-sharing (in-network copay, coinsurance and/or deductible) you owe under your plan.

My in-network primary care physician referred me to an out-of-network doctor, and I saw that doctor without knowing of her out-of-network status. Am I responsible for the costs?

Since you did not consent in writing to get out-of-network care, you are not responsible for any costs other than the applicable in-network cost-sharing you owe under your plan.

I had blood drawn by an in-network provider, but the sample was sent to an out-of-network lab for testing. Am I responsible for the costs?

Since you did not consent in writing to have the blood sample sent to an out-of-network lab, you are not responsible for any costs beyond any applicable in-network cost-sharing you owe under your plan for the service.

Handling Surprise Bills

What should I do if I get a surprise bill from a doctor’s office?

If a doctor sends you a bill for out-of-network emergency services or a surprise bill, he or she must also provide you with a claim form and, for surprise bills, a surprise bill Assignment of Benefits Form, as well. Complete and send these forms, along with a copy of the bill, to EmblemHealth by mail or email for processing.

For instructions on submitting these documents, see the section “What to Do If You Get a Bill for Out-of-Network Emergency Services or a Surprise Bill” on our dedicated web page.

EmblemHealth has already processed a claim for what I believe is a surprise bill, but I am being asked to pay more than my in-network cost-sharing. What should I do?

EmblemHealth will try to identify surprise bills when we first process the claims. In some instances, however, it may not be clear to us that a claim is a surprise bill. In such cases, we may deny the claim if you have only in-network coverage (HMO or EPO plans). Or, if you have out-of-network coverage (PPO or POS plans), we may process the claim according to the terms of your out-of-network coverage.

You should complete and submit to EmblemHealth a standard surprise bill Assignment of Benefits Form, or call Customer Service at the number on your ID card. Customer Service may also ask you to complete and submit the standard surprise bill Assignment of Benefits Form when you call.

If you feel a payment decision is incorrect, you also can file a complaint with EmblemHealth by calling Customer Service or submitting a dispute by mail, in person or by fax.

For instructions on submitting forms and filing grievances, see the section “Disputing Claims for Out-of-Network Emergency Services or Surprise Bills” on our dedicated web page.

Estimating Out-of-Network Care Costs

What is cost-sharing?

Cost-sharing describes the portion of our plan allowances that you are responsible for paying. There are a few types of cost-sharing (i.e., copay, coinsurance and/or deductible) that plan members may need to pay to use covered health services. Cost-sharing does not include premiums, which is the cost of your health care plan either each month or over a given time period. If your plan includes out-of-network coverage, cost-sharing also does not include the difference between the EmblemHealth allowance (the maximum amount we pay for a service) and the charges of an out-of-network provider, which you are also responsible for paying.

If I receive out-of-network emergency services or services that would qualify as a “surprise bill,” will my cost-sharing and out-of-pocket costs be higher than if I had received in-network care?

No. In these cases, your cost-sharing will be at the in-network cost-sharing amount(s), as defined under your plan. See our web page for more information.

Is there any way to estimate what I would pay out of pocket for out-of-network services?

Yes. EmblemHealth has tools you can use to estimate your out-of-pocket costs for specific services from an out-of-network doctor. The tools you should use depend on whether the doctor is inside or outside the provider network for your health plan. For more information, see the section “Estimating Your Out-of-Network Care Costs” on our dedicated web page.

EmblemHealth Provider Networks

How do I know if a doctor participates in my plan’s provider network?

Use our Find a Doctor tool. Once you arrive at the tool, follow the on-screen instructions and select your plan. From there, the system will bring up a list of doctors, hospitals and other health care providers who participate in your plan’s provider network. Always confirm the doctor’s participation in your network when making an appointment.

If a doctor says they participate with EmblemHealth, are they sure to be in my plan’s provider network?

No. Doctors may participate in some EmblemHealth networks, but not in others. So, when you make an appointment to see a doctor, be sure to tell the doctor’s office which EmblemHealth company you are insured with, such as GHI or HIP, and the provider network linked to your plan. Check your member ID card to confirm which company you are insured with and your plan’s provider network.

Will EmblemHealth be making changes to any of its provider networks to account for the new protections for out-of-network emergency services and surprise bills?

No. At this time, EmblemHealth will not be changing our provider networks based on these new protections.

More Information

Where can I get more information on the out-of-network payment protections?

Please visit the dedicated web page of New York State’s Department of Financial Services.

Questions?

Please contact EmblemHealth at the phone number on the back of your member ID card, 8 am to 8 pm, seven days a week (excluding major holidays). TTY/TDD users, please call 711.