N.Y. FIS Law § 607

§ 607. Dispute resolution for surprise bills. (a) Surprise bill\nreceived by an insured who assigns benefits. (1) If an insured assigns\nbenefits to a non-participating physician, the health care plan shall\npay the non-participating physician in accordance with paragraphs two\nand three of this subsection.\n (2) The non-participating physician may bill the health care plan for\nthe health care services rendered, and the health care plan shall pay\nthe non-participating physician the billed amount or attempt to\nnegotiate reimbursement with the non-participating physician.\n (3) If the health care plan's attempts to negotiate reimbursement for\nhealth care services provided by a non-participating physician does not\nresult in a resolution of the payment dispute between the\nnon-participating physician and the health care plan, the health care\nplan shall pay the non-participating physician an amount the health care\nplan determines is reasonable for the health care services rendered,\nexcept for the insured's copayment, coinsurance or deductible, in\naccordance with section three thousand two hundred twenty-four-a of the\ninsurance law.\n (4) Either the health care plan or the non-participating physician may\nsubmit the dispute regarding the surprise bill for review to an\nindependent dispute resolution entity, provided however, the health care\nplan may not submit the dispute unless it has complied with the\nrequirements of paragraphs one, two and three of this subsection.\n (5) The independent dispute resolution entity shall make a\ndetermination within thirty days of receipt of the dispute for review.\n (6) When determining a reasonable fee for the services rendered, the\nindependent dispute resolution entity shall select either the health\ncare plan's payment or the non-participating physician's fee. An\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) Surprise bill received by an insured who does not assign benefits\nor by a patient who is not an insured. (1) An insured who does not\nassign benefits in accordance with subsection (a) of this section or a\npatient who is not an insured and who receives a surprise bill may\nsubmit a dispute regarding the surprise bill for review to an\nindependent dispute resolution entity.\n (2) The independent dispute resolution entity shall determine a\nreasonable fee for the services rendered based upon the conditions and\nfactors set forth in section six hundred four of this article.\n (3) A patient or insured who does not assign benefits in accordance\nwith subsection (a) of this section shall not be required to pay the\nphysician's fee to be eligible to submit the dispute for review to the\nindependent dispute entity.\n (c) The determination of an independent dispute resolution entity\nshall be binding on the patient, physician and health care plan, and\nshall be admissible in any court proceeding between the patient or\ninsured, physician or health care plan, or in any administrative\nproceeding between this state and the physician.\n