Bill S3541-2013

Relates to reimbursement for ambulance services

Relates to reimbursement for ambulance services.

Details

Actions

  • Jan 8, 2014: REFERRED TO INSURANCE
  • Feb 5, 2013: REFERRED TO INSURANCE

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 ambulance 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 assignment 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 insurers 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 ambulance 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 knowledge 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.


Text

STATE OF NEW YORK ________________________________________________________________________ 3541 2013-2014 Regular Sessions IN 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
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.

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