Forensic Rape Exam (FRE)

Forensic Rape Exam (FRE)

If a sexual assault survivor used her insurance to pay for the cost of the exam, but insurance did not cover 100% of the bill, can the hospital or provider charge OVS for the balance?

If a sexual assault survivor used her insurance to pay for the cost of the exam, but insurance did not cover 100% of the bill, can the hospital or provider charge OVS for the balance?

No. Once private health care insurance is assigned, the hospital or healthcare provider may not bill the OVS for any balance due. Most healthcare providers that accept private insurance will accept the insurance payment as “payment in full.” Additionally, a sexual assault survivor may file a full claim application with the OVS and if eligible, be reimbursed for any non-covered medical expenses related to the sexual assault.

I am a medical provider who performed a forensic exam in a hospital where I have privileges, how do I get paid for my services?

I am a medical provider who performed a forensic exam in a hospital where I have privileges, how do I get paid for my services?

You must request payment from the hospital. The OVS will reimburse the hospital or facility in which the forensic examination was conducted. The hospital or facility in which the examination was conducted shall be responsible for proportionately allocating reimbursable expenses among service providers.

I am a private physician who conducted an FRE exam in my office. I did not use a Sexual Offense Evidence Collection Kit. Can I still be reimbursed?

I am a private physician who conducted an FRE exam in my office. I did not use a Sexual Offense Evidence Collection Kit. Can I still be reimbursed?

Yes, so long as the examination was conducted in accordance with Public Health Law §2805(i) and the Department of Health’s Protocols for the Acute Care of the Adult Patient Reporting Sexual Assault, and a diagnosis of sexual assault is indicated on the itemized bill.

Protocols for the Acute Care of the Adult Patient Reporting Sexual Assault, is currently available on the web: Click Here

Does a sexual assault survivor have to have a forensic examination performed right away? What is the timeframe?

Does a sexual assault survivor have to have a forensic examination performed right away? What is the timeframe?

Generally, a forensic exam must be performed within 96 hours of the assault in order to obtain essential evidence. However, the Office of Victim Services will cover the cost of a forensic exam conducted beyond 96 hours for a child victim, or for any victim where good cause is shown for the delay.

Will a sexual assault survivor be required to follow through with prosecution in order to secure payment for the forensic examination?

Will a sexual assault survivor be required to follow through with prosecution in order to secure payment for the forensic examination?

No. A sexual assault survivor will not be required by the Office of Victim Services to pursue prosecution in order to have the sexual assault forensic examination and related services paid for under the direct reimbursement program.

Can a hospital or other forensic examiner bill the victim for the remaining balance after direct reimbursement by the OVS?

Can a hospital or other forensic examiner bill the victim for the remaining balance after direct reimbursement by the OVS?

No. Once the victim chooses that a provider bill the OVS through this program, the provider and any other services providers that provided forensic exam related services, can not bill the victim or the victim's insurance. Additionally, if the provider receives reimbursement through the program, the healthcare provider must accept the OVS reimbursement rate as payment in full for covered and submitted services. The purpose of this Direct Reimbursement Program is to ensure that the sexual assault survivor not be held responsible for the payment of the cost of the forensic examination.

Is follow-up or post-exposure HIV prophylaxis covered under this program?

Is follow-up or post-exposure HIV prophylaxis covered under this program?

No. Only costs for the initial 3-day supply of HIV prophylaxis (effective 11/27/2012, the initial supply to be paid under the FRE will be a 7-day dose pack) are intended to be reimbursed by the Direct Reimbursement Program.

For reimbursement of the expenses associated with follow-up or post-exposure HIV prophylaxis beyond the initial 3-day supply (effective 11/27/2012, 7-day supply), an eligible victim must file a regular claim application form with the OVS. Claim applications are available from the OVS website.

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