Close

Member Secure Log In

Please sign in using the form below
Close

Provider Secure Log In

Please sign in using the form below

1. What is a surprise bill?

A surprise bill is when a member gets services from an out-of-network provider at an in-network hospital or other center and receives a bill for those services.

A member may get a surprise bill because:

  • •An in-network provider was not available
  • •An out-of-network provider gave the member services without his or her knowledge
  • •There was a medical problem or issue that came up at the time of the healthcare services
  • •The member was referred by an in-network provider without his or her written consent and without being informed that the referral may result in costs not covered by his or her health plan
  • •An in-network provider sent a sample taken during a member’s visit to an out-of-network lab or specialist
  • •The member’s primary doctor referred him or her to an out-of-network provider
  • •The member did not choose to get services from an out-of network provider instead of from an available in-network provider

If the member chooses to receive services from an out-of-network provider, charges for the services are not considered surprise bills.

If you are a member and receive a bill that you believe is a surprise bill, please fill out this Assignment of Benefits Form. Sign, scan, and email it to a claimsubmission@healthfirst.org or send by regular mail to:

Healthfirst Inc.
P.O. Box 5165
New York, NY 10274-5165

If we determine that you have received a surprise bill, you will not have to pay charges except for any applicable co-pays, coinsurance, or deductibles. This is sometimes called a “hold harmless” rule.

2. What if Healthfirst pays an out-of-network provider less than what was charged for emergency services?

If a member gets emergency services from an out-of-network provider and Healthfirst paid that provider less than what was charged, the member will not have any costs greater than any applicable co-pays, coinsurance, or deductibles.

In some cases, these costs the member owes may increase. This may happen if an Independent Dispute Resolution Entity (IDRE) decides that Healthfirst must pay the out-of-network provider an amount higher than what Healthfirst originally paid.

If you are a member and get a bill from an out-of-network provider for emergency services, please contact us at 1-888-250-2220.

3. As a provider, can I dispute the costs that Healthfirst has not covered?

If you are a provider and not satisfied with the amount Healthfirst has covered for a surprise bill or out-of-network emergency service, you can submit a complaint to an Independent Dispute Resolution Entity (IDRE).

Find out more about the Independent Dispute Resolution process.

4. As a provider, how do I submit a claim to an IDRE?

To submit a claim to an Independent Dispute Resolution Entity (IDRE), a healthcare provider must:

  • •Visit the Department of Financial Services (DFS) website to receive a file number
  • •Complete this application
  • •Send the application to the assigned Independent Dispute Resolution Entity

5. I have additional questions about surprise bills and Independent Dispute Resolution.

If you have additional questions, please call 1-800-342-3736, or e-mail your questions to IDRquestions@dfs.ny.gov.

Medicaid Managed
Care and Child Health Plus

1-866-463-6743
Monday - Friday, 8am to 6pm
The Essential Plan
and Leaf Plans

1-888-250-2220
Monday - Friday, 8am to 8pm
FIDA Participant Services
1-855-675-7630

TTY English
711
Monday - Sunday, 8am to 8pm
Broker Services:
1-855-456-3668
Monday - Friday, 9am to 5pm
Employer Services
1-855-949-3668
Monday - Friday, 9am to 5pm
Total Plan and Pro Plan Members
1-855-789-3668
TTY English: 1-855-779-1033
Monday - Friday, 8am to 6pm
Senior Health Partners
1-866-585-9280

TTY English
Monday - Friday, 8am to 8pm
Saturday, 10am to 6:30pm

TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Current Medicare
Plan Members

1-888-260-1010
Monday - Sunday, 8am to 8pm

Become a Medicare
Plan Member

1-877-237-1303
Monday - Sunday, 8am to 8pm

TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Personal Wellness Plan
1-855-659-5971
TTY
1-888-542-3821
7 days a week, 24 hours a day
We can call you