CurrentOscar HealthPolicy N/A

Independent Dispute Resolution for Emergency Surprise Bills

Describes the New York State Independent Dispute Resolution (IDR) process available beginning April 1, 2015 for resolving out-of-network 'surprise' emergency service bills and explains how members and providers can initiate disputes involving Oscar Health.

Policy Summary

PayerOscar Health

PolicyIndependent Dispute Resolution for Emergency Surprise Bills

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateApr 1, 2015

Next Review DateN/A

Key ActionMembers submit an Assignment of Benefits form to Oscar (email NYIDRE@hioscar.com or fax (888) 977-2062) so Oscar can file an IDR application and may negotiate on their behalf.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Apr 1, 2015IDR process effective date

1IDRE involved

855-OSCAR-55Customer support

IDR Submission Criteria

IDR Submission Steps

How members and providers can initiate an IDR dispute with Oscar or directly with DFS:

Members contact Oscar via email, phone, or fax with information from the bill they wish to dispute.

Members submit an Assignment of Benefits form to Oscar as instructed (email to NYIDRE@hioscar.com or fax (888) 977-2062).

Oscar will submit an IDR application and may enter into negotiation with the provider on the member's behalf.

Provider options

Providers may submit the IDR application directly to DFS.

Policy Summary

PayerOscar Health

PolicyIndependent Dispute Resolution for Emergency Surprise Bills

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateApr 1, 2015

Next Review DateN/A

Key ActionMembers submit an Assignment of Benefits form to Oscar (email NYIDRE@hioscar.com or fax (888) 977-2062) so Oscar can file an IDR application and may negotiate on their behalf.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider & Payer Submission Procedures

Documentation Required

Provider may submit IDR directly to DFS or contact Oscar; use required provider forms

Providers may submit the IDR application directly to the New York Department of Financial Services (DFS) or contact Oscar to initiate the process; providers must use the required provider forms linked in the document.

Submit the IDR application directly to DFS or contact Oscar to initiate submission.
Use the required provider forms provided/linked in the policy.

Prior Authorization

Oscar may file IDR and negotiate with provider when Assignment of Benefits is provided

Oscar may submit an IDR application and may enter into negotiations with the provider on behalf of a member when provided with an Assignment of Benefits form.

Members should submit an Assignment of Benefits form to Oscar (email to NYIDRE@hioscar.com or fax (888) 977-2062) to enable Oscar to file and negotiate on their behalf.
Oscar will submit the IDR application and may negotiate with the provider for resolution.

Key Terms

Independent Dispute Resolution Entity (IDRE)

DefinitionIndependent Dispute Resolution Entity (IDRE): an independent third party that helps health plans and providers negotiate and settle appropriate charges on surprise out-of-network emergency bills.

RoleFacilitates negotiation and settlement between health plans (like Oscar) and providers for disputed surprise emergency service charges.

AuthorityOperates under New York State 'Emergency Services Surprise Bill Law' effective April 1, 2015.

AccessAvailable to members, providers, and health plans to resolve disputes over surprise out-of-network emergency bills.

Independent Dispute Resolution (IDR) Process

DefinitionIndependent Dispute Resolution (IDR): the formal process by which members, providers, and health plans resolve disputes over surprise out-of-network emergency service billing.

Initiation by MemberMembers contact Oscar via email, phone, or fax with bill information and submit an Assignment of Benefits form for Oscar to file the IDR application on their behalf.

Initiation by ProviderProviders may submit the IDR application directly to DFS or contact Oscar to initiate the process using required provider forms.

Payer RoleOscar will submit an IDR application and may enter into negotiation with the provider on the member's behalf when provided the Assignment of Benefits.

Effective DateIDR process available beginning April 1, 2015 under New York regulation.