New York Medical Billing Fairness & Debt Relief Act

Section 1. Title

This act shall be known and may be cited as the “New York Medical Billing Fairness & Debt Relief Act.”

Section 2. Legislative Findings & Intent

The Legislature finds that:

Medical costs are a leading cause of financial hardship for New York residents;
Patients frequently receive bills they do not understand, cannot predict, or cannot afford;
Even with insurance, high out-of-pocket costs and billing practices can lead to long-term debt;

Therefore, the purpose of this act is to:

Protect patients from unfair and excessive medical billing practices;
Increase transparency and predictability in healthcare costs;
Reduce the burden of medical debt on New York residents;
Establish oversight, accountability, and protections against abuse.
Section 3. Definitions
“Healthcare Provider” means any hospital, clinic, physician, or licensed healthcare facility operating in New York State.
“Medical Debt” means any debt incurred for medically necessary healthcare services.
“Good Faith Estimate” means a written estimate of expected charges provided prior to non-emergency care.
Section 4. Upfront Cost Transparency

(a) Healthcare providers shall provide a Good Faith Estimate for all non-emergency services upon request and prior to service.

(b) Such estimate shall include:

Expected total cost
Breakdown of major services and fees
Notice of potential additional charges

(c) Final bills exceeding the estimate by more than a defined threshold (e.g., 10–15%) must be justified and subject to dispute.

Section 5. Prohibition of Surprise Billing Expansion

(a) No patient shall be billed for out-of-network charges in situations where:

The patient did not knowingly choose an out-of-network provider;
Services were provided at an in-network facility;

(b) Any disputes shall be resolved between insurers and providers without burdening the patient.

Section 6. Medical Debt Interest & Payment Protections

(a) Interest on medical debt shall be capped at a low rate (e.g., 0–3% annually).

(b) Healthcare providers must offer:

Interest-free payment plans for a defined period;
Income-based repayment options for qualifying patients;

(c) No medical debt shall be reported to credit agencies until:

A minimum waiting period (e.g., 180–365 days) has passed;
The patient has been offered reasonable repayment options;
Section 7. Plain Language Billing Requirements

(a) All medical bills must:

Be written in plain, understandable language;
Clearly itemize charges;
Include contact information for billing assistance;

(b) Patients shall have the right to request and receive a detailed explanation of charges.

Section 8. Program Integrity & Anti-Abuse Protections

(a) Providers participating in state-regulated programs or receiving public funds shall:

Maintain accurate billing practices;
Avoid duplicate or inflated charges;

(b) The state shall establish:

Auditing procedures to detect overbilling or fraud;
Benchmarks to identify excessive or abnormal pricing;

(c) Any provider found to be engaging in fraudulent or abusive billing practices shall be subject to:

Financial penalties
Repayment obligations
Potential exclusion from state programs
Section 9. Oversight and Enforcement

(a) The New York State Department of Health and the New York State Attorney General shall:

Enforce provisions of this act;
Investigate complaints;
Conduct audits and compliance reviews;

(b) A public complaint system shall be established for patients to report violations.

Section 10. Penalties

(a) Violations of this act shall result in:

Civil fines;
Refunds or credits to affected patients;
Corrective action requirements;

(b) Repeated or willful violations may result in:

Enhanced penalties;
Suspension or restriction of operating privileges;
Section 11. Severability

If any provision of this act is held invalid, such invalidity shall not affect the remaining provisions.

Section 12. Effective Date

This act shall take effect within a defined period following adoption.