N.Y. FIS Law § 605

§ 605. Dispute resolution for emergency services. (a) Emergency\nservices for an insured. (1) When a health care plan receives a bill for\nemergency services from a non-participating physician, the health care\nplan shall pay an amount that it determines is reasonable for the\nemergency services rendered by the non-participating physician, in\naccordance with section three thousand two hundred twenty-four-a of the\ninsurance law, except for the insured's co-payment, coinsurance or\ndeductible, if any, and shall ensure that the insured shall incur no\ngreater out-of-pocket costs for the emergency services than the insured\nwould have incurred with a participating physician pursuant to\nsubsection (c) of section three thousand two hundred forty-one of the\ninsurance law.\n (2) A non-participating physician or a health care plan may submit a\ndispute regarding a fee or payment for emergency services for review to\nan independent dispute resolution entity.\n (3) The independent dispute resolution entity shall make a\ndetermination within thirty days of receipt of the dispute for review.\n (4) In determining a reasonable fee for the services rendered, an\nindependent dispute resolution entity shall select either the health\ncare plan's payment or the non-participating physician's fee. The\nindependent dispute resolution entity shall determine which amount to\nselect based upon the conditions and factors set forth in section six\nhundred four of this article. If an independent dispute resolution\nentity determines, based on the health care plan's payment and the\nnon-participating physician's fee, that a settlement between the health\ncare plan and non-participating physician is reasonably likely, or that\nboth the health care plan's payment and the non-participating\nphysician's fee represent unreasonable extremes, then the independent\ndispute resolution entity may direct both parties to attempt a good\nfaith negotiation for settlement. The health care plan and\nnon-participating physician may be granted up to ten business days for\nthis negotiation, which shall run concurrently with the thirty day\nperiod for dispute resolution.\n (b) Emergency services for a patient that is not an insured. (1) A\npatient that is not an insured or the patient's physician may submit a\ndispute regarding a fee for emergency services for review to an\nindependent dispute resolution entity upon approval of the\nsuperintendent.\n (2) An independent dispute resolution entity shall determine a\nreasonable fee for the services based upon the same conditions and\nfactors set forth in section six hundred four of this article.\n (3) A patient that is not an insured shall not be required to pay the\nphysician's fee in order to be eligible to submit the dispute for review\nto an independent dispute resolution entity.\n (c) The determination of an independent dispute resolution entity\nshall be binding on the health care plan, physician and patient, and\nshall be admissible in any court proceeding between the health care\nplan, physician or patient, or in any administrative proceeding between\nthis state and the physician.\n