Bill S2637A-2013

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery and such physician's services shall not be covered by their insurance policy; such services must be covered if the insured person does not receive notification prior to such services or procedure.

Details

Actions

  • Feb 10, 2014: PRINT NUMBER 2637A
  • Feb 10, 2014: AMEND AND RECOMMIT TO INSURANCE
  • Jan 8, 2014: REFERRED TO INSURANCE
  • Jan 23, 2013: REFERRED TO INSURANCE

Memo

BILL NUMBER:S2637A

TITLE OF BILL: An act to amend the insurance law, in relation to requiring notification to insured persons that an out-of-network physician may be used in their procedure, test or surgery

PURPOSE OR GENERAL IDEA OF BILL:

To provide notice to patients that services provided may not be covered by health insurance.

SUMMARY OF SPECIFIC PROVISIONS:

Section 3216 of the insurance law is amended by adding a new subsection (n); and Section 3221 of the insurance law is amended by adding anew subsection (t).

JUSTIFICATION:

Very often out of network providers perform services to patients without Patients being made aware that they will be responsible for payment for such services as the provider is not a participating physician of the patient's insurance carrier. An example would be an anesthesiologist who meets a patient shortly before surgery. If the anesthesiologist is not a participating provider, the patient will receive a bill and be responsible for payment. Had the anesthesiologist been a participating provider, the Patient would only be responsible for a co-payment. If a patient is informed who the provider will be before services are rendered they have the opportunity to arrange for a different provider, one which participates with their insurance plan.

PRIOR LEGISLATIVE HISTORY:

2011-12: S.1119/A.495 - Referred to Insurance 2009-10: S.7186/A.9773 - Referred to Insurance 2007-08: A.10124B

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

This act shall take effect immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 2637--A 2013-2014 Regular Sessions IN SENATE January 23, 2013 ___________
Introduced by Sen. PARKER -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to requiring notification to insured persons that an out-of-network physician may be used in their procedure, test or surgery THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 3216 of the insurance law is amended by adding a new subsection (n) to read as follows: (N) (1) EVERY PERSON INSURED UNDER A POLICY OF ACCIDENT AND HEALTH INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE ENTI- TLED TO NOTIFICATION FROM THE BILLING ENTITY PRIOR TO THE PROCEDURE, TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE USED IN SUCH PROCEDURE, TEST OR SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE COVERED BY THEIR INSURANCE POLICY. (2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN SERVICES SHALL BE COVERED BY THE INSURANCE POLICY OF AN INSURED PERSON IF HE OR SHE HAS NOT RECEIVED NOTIFICATION OF SUCH SITUATIONS, PRIOR TO THE HEALTH SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION. S 2. Section 3221 of the insurance law is amended by adding a new subsection (t) to read as follows: (T) (1) EVERY PERSON INSURED UNDER A POLICY OF ACCIDENT AND HEALTH INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE ENTI- TLED TO NOTIFICATION FROM THE BILLING ENTITY PRIOR TO THE PROCEDURE, TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE USED IN SUCH PROCEDURE, TEST OR SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE COVERED BY THEIR INSURANCE POLICY.
(2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN SERVICES SHALL BE COVERED BY THE INSURANCE POLICY OF AN INSURED PERSON IF HE OR SHE HAS NOT RECEIVED NOTIFICATION OF SUCH SITUATIONS, PRIOR TO THE HEALTH SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION. S 3. This act shall take effect immediately.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Discuss!

blog comments powered by Disqus