S2714-2011 Actions

• Jan 4, 2012: REFERRED TO INSURANCE
• Jun 24, 2011: COMMITTED TO RULES
• Jun 14, 2011: AMENDED ON THIRD READING 2714B
• Jun 13, 2011: ADVANCED TO THIRD READING
• Jun 13, 2011: AMENDED 2714A
• Jun 7, 2011: 2ND REPORT CAL.
• Jun 6, 2011: 1ST REPORT CAL.1020
• Jan 31, 2011: REFERRED TO INSURANCE

S2714-2011 Meetings

S2714-2011 Calendars

S2714-2011 Votes

S2714-2011 Memo

BILL NUMBER:S2714

TITLE OF BILL:
An act
to amend the insurance law, in relation to payments to prehospital
emergency medical services providers

PURPOSE:
To ensure that responding ambulance service companies receive
direct payment for all ambulance service transports upon submission
of an invoice to the insurance company without the need for the
responding ambulance company to be a preferred provider.

SUMMARY OF PROVISIONS:
Section 1 amends section 3224-a of the
insurance law to provide that payments made to nonparticipating or
non-preferred providers of ambulance services made by health insurers
shall be done so directly to the provider or jointly to both the
provider and the insured.

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of
subsection (i) of section 321 6 of the insurance law stating that the
insurers shall send such payments directly to the provider of such
ambulance services if the ambulance service includes an executed
assignment of benefits form with the claim and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of
subsection (1) of section 3221 of the insurance law stating that the
insurers shall send such payments directly to the provider of such
ambulance services if the ambulance service includes an executed
assignment of benefits form with the claim and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 4. Effective Date.

JUSTIFICATION:
The constant and quick availability of ambulance
response is something that all of our citizens have grown accustomed
to and it is essential to the survivability of all New Yorkers when
there is a medical crisis, Fair and direct reimbursement for those
services is paramount to the financial stability and continued
availability of ambulances to respond.

Current law permits insurance companies to pay for ambulance service
charges direct to the patient until and unless the ambulance company
becomes a preferred provider of that specific insurance company. It
is not practical to expect a preferred provider relationship with
every insurance company. But then it is the responsibility of the

ambulance company to try to recoup payment for service from that
patient.

All types of EMS providers routinely are not paid by the patient for
ambulance services even though the patient receives payment from the
insurance company. Especially as the financial crisis we are
currently facing deepens, more and more patients are pocketing these
funds. Further, the insurance company is not obligated to advise the
ambulance company that they in fact paid the ambulance transport bill
direct to the patient. This disconnect of information leads to
confusion and furthers the lack of proper payment issue.

In New York State, ambulance companies are mandated responders. As
such, most ambulance providers have no knowledge of the patient's
ability to payor if or by whom they are insured by when a medical
emergency or
accidental event occurs. Ambulance service is one of the few medical
services where payment is not expected at the time of service.

This legislation will assure that responding ambulance service will
receive direct payment for all ambulance service transports upon
submission of an invoice to the insurance company without the need
for the responding ambulance company to be a preferred provider.

LEGISLATIVE HISTORY:
S.4462 of 2010

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect January 1, 2012 and shall
apply to health care claims submitted for payment after such date.

S2714-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 
                                         2714
 2011-2012 Regular Sessions
 I N  SENATE
 January 31, 2011
 
 Introduced  by  Sen.  SEWARD -- read twice and ordered printed, and when
 printed to be committed to the Committee on Insurance
 

AN ACT to amend the insurance law, in relation to payments to  prehospi
 tal emergency medical services providers
 

THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM
 BLY, DO ENACT AS FOLLOWS:

 

Section 1.

Section 3224-a of the insurance law is amended by adding  a
 new subsection (i) to read as follows:

 (I)  PAYMENTS  TO  NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU
 LANCE SERVICES LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC  HEALTH  LAW.
 (1) WHENEVER AN INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI
 FIED  PURSUANT  TO  ARTICLE  FORTY-THREE  OF  THIS  CHAPTER  OR  ARTICLE
 FORTY-FOUR OF THE PUBLIC HEALTH LAW PROVIDES THAT ANY HEALTH CARE CLAIMS
 SUBMITTED UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED INTO  PURSUANT
 TO  THIS  ARTICLE  OR ARTICLES FORTY-TWO AND FORTY-THREE OF THIS CHAPTER
 AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW ARE PAYABLE TO A PARTIC
 IPATING  OR  PREFERRED  PROVIDER  OF  AMBULANCE  SERVICES  FOR  SERVICES
 RENDERED,  THE  INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI
 FIED  PURSUANT  TO  ARTICLE  FORTY-THREE  OF  THIS  CHAPTER  OR  ARTICLE
 FORTY-FOUR  OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO PAY SUCH BENE
 FITS EITHER DIRECTLY  TO  ANY  SIMILARLY  LICENSED  NONPARTICIPATING  OR
 NONPREFERRED  PROVIDER  AT  SAID  PROVIDER'S USUAL AND CUSTOMARY CHARGE,
 WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE,  WHEN  SAID  PROVIDER  HAS
 RENDERED  SUCH  SERVICES,  HAS A WRITTEN ASSIGNMENT OF BENEFITS, AND HAS
 CAUSED WRITTEN NOTICE OF SUCH ASSIGNMENT TO BE  GIVEN  TO  THE  INSURER,
 ORGANIZATION,  OR  CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTICLE
 FORTY-THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE  PUBLIC  HEALTH
 LAW  OR JOINTLY TO SUCH NONPARTICIPATING OR NONPREFERRED PROVIDER AND TO
 THE INSURED, SUBSCRIBER, OR OTHER  COVERED  PERSON;  PROVIDED,  HOWEVER,
 THAT  IN  EITHER CASE THE INSURER, ORGANIZATION, OR CORPORATION LICENSED
 OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR  ARTICLE
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD04592-01-1
 
       S. 2714                             2
 FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENE
 FIT  PAYMENTS  DIRECTLY  TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT.
 WHEN PAYMENT IS MADE DIRECTLY TO A PROVIDER  OF  AMBULANCE  SERVICES  AS
 AUTHORIZED  BY  THIS  SECTION, THE INSURER, ORGANIZATION, OR CORPORATION
 LICENSED OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR
 ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF
 SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
 (2) NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO PROHIBIT  THE
 PAYMENT  OF  DIFFERENT  LEVELS OF BENEFITS OR FROM HAVING DIFFERENCES IN
 COINSURANCE  PERCENTAGES  APPLICABLE  TO  BENEFIT  LEVELS  FOR  SERVICES
 PROVIDED BY PARTICIPATING OR PREFERRED PROVIDERS AND NONPARTICIPATING OR
 NONPREFERRED PROVIDERS.
 (3)  THE  PROVISIONS  OF THIS SECTION SHALL NOT APPLY TO CREDIT INSUR
 ANCE, DISABILITY INCOME INSURANCE,  OR  LIMITED  ACCIDENT  AND  SICKNESS
 POLICIES  SUCH  AS  HOSPITAL INDEMNITY POLICIES, SPECIFIED DISEASE POLI
 CIES, LIMITED ACCIDENT POLICIES, OR SIMILAR LIMITED POLICIES.
 

S 2. Subparagraphs (C) and (D) of paragraph 24 of  subsection  (i)  of
 section  3216  of the insurance law, as added by chapter 506 of the laws
 of 2001, are amended to read as follows:

 (C)  An  insurer  shall  provide  reimbursement  for  those   services
 prescribed  by  this section at rates negotiated between the insurer and
 the provider of such services. In the absence of agreed upon  rates,  an
 insurer  shall  pay for such services at the usual and customary charge,
 which shall not be excessive or unreasonable.   THE INSURER  SHALL  SEND
 SUCH  PAYMENTS  DIRECTLY  TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF
 THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF  BENEFITS  FORM
 WITH THE CLAIM.
 (D)  The  provisions  of this paragraph shall have [no] application to
 transfers of patients between hospitals or health care facilities by  an
 ambulance service as described in subparagraph (A) of this paragraph.
 

S  3.  Subparagraphs  (C) and (D) of paragraph 15 of subsection (l) of
 section 3221 of the insurance law, as added by chapter 506 of  the  laws
 of 2001, are amended to read as follows:

 (C)   An  insurer  shall  provide  reimbursement  for  those  services
 prescribed by this section at rates negotiated between the  insurer  and
 the  provider  of such services. In the absence of agreed upon rates, an
 insurer shall pay for such services at the usual and  customary  charge,
 which  shall  not  be excessive or unreasonable.  THE INSURER SHALL SEND
 SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH  AMBULANCE  SERVICES,  IF
 THE  AMBULANCE  SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM
 WITH THE CLAIM.
 (D) The provisions of this paragraph shall have  [no]  application  to
 transfers  of patients between hospitals or health care facilities by an
 ambulance service as described in subparagraph (A) of this paragraph.
 

S 4. This act shall take effect January 1, 2012  and  shall  apply  to
 health care claims submitted for payment after such date.

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