S3541-2013 Actions

• Feb 5, 2013: REFERRED TO INSURANCE

S3541-2013 Memo

BILL NUMBER:S3541

TITLE  OF  BILL:    An  act  to  amend the insurance law, in relation to
reimbursement for ambulance services

PURPOSE: To require insurers to submit payments  directly  to  ambulance
providers who are in-network or, for out-of-network ambulance providers,
to  require the issuance of a joint check to the insured specifying both
the insured and the ambulance provider as payees.

SUMMARY OF PROVISIONS:  Amends  sections  3216(i)(24),  3221(1)(15)  and
4303(aa)  to  require insurers to submit payments directly to in-network
ambulance providers at the negotiated rates For out-of-network ambulance
providers where there is no negotiated rate, the insurer is required  to
issue a joint check to the insured specifying both the insured and ambu-
lance provider as payees, at the usual and customary charge.

Further,  the  legislation  requires  the insurer to issue reimbursement
directly to the ambulance provider if the insured has filed  an  assign-
ment of benefits for such ambulance services.

The  legislation  also  requires  the  insurer  to  notify the ambulance
provider electronically upon the  issuance  of  a  joint  check  to  the
insured.  The notification must include the name of the patient, date of
service, date of payment, amount of payment and  address  to  which  the
payment was sent.

JUSTIFICATION: This bill would amend the insurance law to require insur-
ers  to  issue  joint signature checks to both the patient and ambulance
service provider when the patient utilizes an ambulance service provider
that is a non-participating provider of their network.

Currently, when a patient uses  an  out-of-network  ambulance  provider,
their  insurance  company  will send the ambulance reimbursement payment
directly to the patient. The patient is then expected  to  forward  that
reimbursement  payment  to  the  ambulance  service  that  provided  the
service. In many cases with a single signature check, the patients never
send the insurance reimbursement to the service provider.  Rather,  they
keep  the  money  for themselves, diverting millions of dollars from our
healthcare system in the process.

This bill would insure that healthcare dollars stay  in  the  healthcare
system and that healthcare providers are paid for the work that they do.
In  order  to  cash  the  check,  both parties would need to endorse the
check. Insurers would send the joint signature check to the patient, the
patient would sign it and send it to the ambulance  provider  The  ambu-
lance  provider  could  then  endorse  the  check  and be paid for their
service. The insurer will also notify  the  ambulance  provider  when  a
joint signature check has been sent to the patient.

Ambulance  providers  are  mandated responders who must provider service
when an emergency call comes in. They answer these calls  without  know-
ledge  of a patient's ability to pay and without concern of getting paid
at the time of service But in order to keep the ambulance system  strong
and viable they must collect payment for service. This bill would assist
in collecting payments.

LEGISLATIVE HISTORY: S.6982 of 2012

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately.

S3541-2013 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

                                    3541

                         2013-2014 Regular Sessions

                              I N  SENATE

                              February 5, 2013
                                 ___________

  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  reimbursement  for
    ambulance services

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


    Section 1. Paragraph 24 of subsection  (i)  of  section  3216  of  the
  insurance  law  is  amended  by adding a new subparagraph (F) to read as
  follows:

    (F) AN INSURER WHO ISSUES REIMBURSEMENT  UNDER  THIS  PARAGRAPH  SHALL
  SUBMIT  SUCH PAYMENTS EITHER DIRECTLY TO THE PROVIDER AT THE RATES NEGO-
  TIATED BETWEEN THE PROVIDER AND THE INSURER, OR IF NO    RATE  HAS  BEEN
  NEGOTIATED  BETWEEN THE PROVIDER AND INSURER, THEN TO THE INSURED IN THE
  FORM OF A JOINT CHECK SPECIFYING AS PAYEES  BOTH  THE  INSURED  AND  THE
  PROVIDER OF AMBULANCE SERVICES, AT THE USUAL AND CUSTOMARY CHARGE, WHICH
  SHALL NOT BE EXCESSIVE OR UNREASONABLE; PROVIDED HOWEVER, IF THE PROVID-
  ER OF AMBULANCE SERVICES HAS ON FILE A DULY EXECUTED ASSIGNMENT OF BENE-
  FITS  FOR  SUCH  SERVICES  TO  THE  INSURER,  NOTWITHSTANDING ANY POLICY
  LANGUAGE TO THE CONTRARY, THE ISSUER SHALL  ACCEPT  SUCH  ASSIGNMENT  OF
  BENEFITS AND THE INSURER SHALL ISSUE REIMBURSEMENT SOLELY TO THE PROVID-
  ER. AN INSURER ISSUING PAYMENT IN THE FORM OF A JOINT CHECK SHALL NOTIFY
  THE  PROVIDER  VIA  ELECTRONIC  COMMUNICATION  OF  THE  ISSUANCE OF SUCH
  PAYMENT. THE NOTIFICATION SHALL INCLUDE THE NAME  OF  THE  PATIENT,  THE
  DATE  OF  SERVICE,  THE  DATE  OF PAYMENT, THE AMOUNT OF PAYMENT AND THE
  ADDRESS TO WHICH THE PAYMENT WAS SENT.
    S 2.  Paragraph 15 of subsection (1) of section 3221 of the  insurance
  law is amended by adding a new subparagraph (F) to read as follows:

    (F)  AN  INSURER  WHO  ISSUES REIMBURSEMENT UNDER THIS PARAGRAPH SHALL
  SUBMIT SUCH PAYMENTS EITHER DIRECTLY TO THE PROVIDER AT THE RATES  NEGO-
  TIATED  BETWEEN  THE  PROVIDER  AND  THE INSURER, OR IF NO RATE HAS BEEN
  NEGOTIATED BETWEEN THE PROVIDER AND INSURER, THEN TO THE INSURED IN  THE

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD07580-01-3

 S. 3541                             2

  FORM  OF  A  JOINT  CHECK  SPECIFYING AS PAYEES BOTH THE INSURED AND THE
  PROVIDER OF AMBULANCE SERVICES, AT THE USUAL AND CUSTOMARY CHARGE, WHICH
  SHALL NOT BE EXCESSIVE OR UNREASONABLE; PROVIDED HOWEVER, IF THE PROVID-
  ER OF AMBULANCE SERVICES HAS ON FILE A DULY EXECUTED ASSIGNMENT OF BENE-
  FITS  FOR  SUCH  SERVICES  TO  THE  INSURER,  NOTWITHSTANDING ANY POLICY
  LANGUAGE TO THE CONTRARY, THE INSURER SHALL ACCEPT  SUCH  ASSIGNMENT  OF
  BENEFITS AND THE INSURER SHALL ISSUE REIMBURSEMENT SOLELY TO THE PROVID-
  ER. AN INSURER ISSUING PAYMENT IN THE FORM OF A JOINT CHECK SHALL NOTIFY
  THE  PROVIDER  VIA  ELECTRONIC  COMMUNICATION  OF  THE  ISSUANCE OF SUCH
  PAYMENT. THE NOTIFICATION SHALL INCLUDE THE NAME  OF  THE  PATIENT,  THE
  DATE  OF  SERVICE,  THE  DATE  OF PAYMENT, THE AMOUNT OF PAYMENT AND THE
  ADDRESS TO WHICH THE PAYMENT WAS SENT.
    S 3. Subsection (aa) of section 4303 of the insurance law  is  amended
  by adding a new paragraph 6 to read as follows:

    (6)  AN  INSURER  WHO  ISSUES REIMBURSEMENT UNDER THIS PARAGRAPH SHALL
  SUBMIT SUCH PAYMENTS EITHER DIRECTLY TO THE PROVIDER AT THE RATES  NEGO-
  TIATED  BETWEEN  THE  PROVIDER  AND  THE INSURER, OR IF NO RATE HAS BEEN
  NEGOTIATED BETWEEN THE PROVIDER AND INSURER, THEN TO THE INSURED IN  THE
  FORM  OF  A  JOINT  CHECK  SPECIFYING AS PAYEES BOTH THE INSURED AND THE
  PROVIDER OF AMBULANCE SERVICES, AT THE USUAL AND CUSTOMARY CHARGE, WHICH
  SHALL NOT BE EXCESSIVE OR UNREASONABLE; PROVIDED HOWEVER, IF THE PROVID-
  ER OF AMBULANCE SERVICES HAS ON FILE A DULY EXECUTED ASSIGNMENT OF BENE-
  FITS FOR SUCH  SERVICES  TO  THE  INSURER,  NOTWITHSTANDING  ANY  POLICY
  LANGUAGE  TO  THE  CONTRARY, THE INSURER SHALL ACCEPT SUCH ASSIGNMENT OF
  BENEFITS AND THE INSURER SHALL ISSUE REIMBURSEMENT SOLELY TO THE PROVID-
  ER. AN INSURER ISSUING PAYMENT IN THE FORM OF A JOINT CHECK SHALL NOTIFY
  THE PROVIDER VIA  ELECTRONIC  COMMUNICATION  OF  THE  ISSUANCE  OF  SUCH
  PAYMENT.  THE  NOTIFICATION  SHALL  INCLUDE THE NAME OF THE PATIENT, THE
  DATE OF SERVICE, THE DATE OF PAYMENT, THE  AMOUNT  OF  PAYMENT  AND  THE
  ADDRESS TO WHICH THE PAYMENT WAS SENT.
    S 4. This act shall take effect immediately.