Northwell Mather Hospital - Online Bill Pay

What to do if you receive a surprise bill

You can dispute a surprise medical bill.

Patients with insurance (coverage with HMO or insurer subject to New York state law, or coverage that is not self-insured): You will be protected from a surprise bill and will be responsible only for an in-network copayment, coinsurance or deductible if you do both of the following:

  • Sign a Payment Authorization Form to permit the facility and/or provider to seek payment for the bill from your health insurance plan.
  • Send the form to your health insurance plan and your provider or the applicable facility, and include a copy of the bill or bills you do not think you should pay. You can contact your insurance company directly for information related to where these types of forms and supporting documentation should be sent.

Uninsured patients or patients with employer or union self-insured coverage, or insured patients who do not assign benefits for surprise bills—If you are uninsured or your employer or union self-insures, you may dispute a surprise bill by using the New York state independent dispute resolution (IDR) process. To submit a dispute, you must complete the IDR patient application and send it to:

NYS Department of Financial Services
Consumer Assistance Unit/IDR Process
One Commerce Plaza
Albany, NY 12257

This process includes several components, including an independent dispute resolution entity (IDRE) that reviews the dispute. Decisions will be made by a reviewer with training and experience in health care billing, reimbursement, and usual and customary charges, in consultation with a licensed doctor in active practice in the same or a similar specialty as the doctor providing the service that is the subject of the dispute. The IDRE will make a determination within 30 days of receipt of the dispute.

Questions about submitting a dispute

Contact the New York State Department of Financial Services at (800) 342-3736 or email if you have questions or need help.