Source: http://open.nysenate.gov/legislation/bill/S2551-2013
Timestamp: 2015-04-01 21:18:07
Document Index: 571603322

Matched Legal Cases: ['§23', '§4408', 'Art 7', '§701', '§ 3217', '§ 3420', '§ 3217', '§ 3217', '§ 3217', '§ 3224', '§ 3240', '§ 4306', '§ 4324', '§ 4324', '§ 4324', '§ 23', '§ 24']

S2551-2013 - NY Senate Open Legislation - Establishes protections to prevent surprise medical bills - New York State Senate
Bill S2551-2013
Establishes protections to prevent surprise medical bills
A7253-2013
S2551-2013 Sponsor:HANNON
AVELLA, BALL, CARLUCCI, GOLDEN, HOYLMAN, KRUEGER, LARKIN, LATIMER, LAVALLE, MARTINS, RANZENHOFER, YOUNG
Law: Amd Ins L, generally; add §§23 & 24, amd §§4408, 4900, 4903, 4904, 4910 & 4914, Pub Health L; add Art 7 §§701 - 704, Fin Serv L
Jun 20, 2013: referred to insurance
Jun 20, 2013: ORDERED TO THIRD READING CAL.1478
Jan 18, 2013: REFERRED TO INSURANCE
Adams, Addabbo, Avella, Ball, Bonacic, Boyle, Breslin, Carlucci, DeFrancisco, Diaz, Dilan, Espaillat, Farley, Felder, Flanagan, Fuschillo, Gallivan, Gianaris, Gipson, Golden, Griffo, Grisanti, Hannon, Hassell-Thomps, Hoylman, Kennedy, Klein, Krueger, Lanza, Larkin, Latimer, LaValle, Libous, Little, Marcellino, Marchione, Martins, Maziarz, Montgomery, Nozzolio, O'Brien, O'Mara, Parker, Peralta, Perkins, Ranzenhofer, Ritchie, Rivera, Robach, Sampson, Sanders, Savino, Serrano, Skelos, Smith, Squadron, Stavisky, Stewart-Cousin, Tkaczyk, Valesky, Young, Zeldin
BILL NUMBER:S2551TITLE OF BILL: An act to amend the insurance law, the public health law and the financial services law, in relation to establishing protections to prevent surprise medical bills including network adequacy requirements, claim submission requirements, adequacy of and access to out-of-network care and prohibition of excessive emergency charges; and providing for the repeal of certain provisions upon expiration thereofPURPOSE: This bill establishes consumer protections from surprise medical bills by: requiring certain disclosures from insurers, health care providers and hospitals; requiring adequate access to care; establishing a minimum reimbursement for out-of-network services; and prohibiting excessive emergency room charges.SUMMARY OF PROVISIONS:Section one amends Insurance Law § 3217-a(a) to make several conforming changes and require insurers to provide several additional disclosures. For all policies offering out-of-network coverage pursuant to § 3420(b)&(c) of this article, the insurer must provide a clear description of the methodology used to determine reimbursement for out-of-network health care services, including a description of the amount set forth as a percentage of the usual and customary cost for out-of-network health care services and examples of anticipated out-of-pocket costs.Section two amends Insurance Law § 3217-a(b) to require the insurer disclose, upon request, whether a health care provider scheduled to perform services is in-network and where applicable, 1) the dollar amount the insurer will pay for specific out-of-network services, and 2) information permitting an insured or prospective insured to determine anticipated out-of-pocket costs for out-of-network services in a geographical area, based upon the difference the insurer will reimburse and the usual and customary cost.Section three amends Insurance Law § 3217-a(f) to define the usual and customary cost as the eightieth percentile of all charges for a particular health care service performed in the same or similar specialty and provided in the same geographical area as reported by FAIR Health, Inc.Section four amends Insurance Law § 3217-d(d) to provide that comprehensive policies under this article must provide access to out-of-network services if there is no in-network provider.Section five amends Insurance Law § 3224-a to require an insurer, a corporation or organization under Article 43 or Article 47 of this chapter and HMOs under Article 44 of the Public Health Law to accept claims submitted through the internet, e-mail or fax. Section six adds a new § 3240 to the Insurance Law. Section 3240(a) requires that an insurer, a corporation organized pursuant to Article 43 and a municipal cooperative health benefit plan under Article 47 of this chapter maintain an adequate network. Sections 3240(b) & (c) requires an insurer, a corporation organized pursuant to Article 43, a municipal cooperative health benefit plan certified under Article 47 of this Chapter and an HMO under article 44 of the Public Health Law to provide: 1) significant coverage of the usual and customary cost of out-of-network services; and 2) to offer at least one policy or contract option in each geographical region covered that provides coverage for at least 80% of the usual and customary cost of out-of-network health care services, after imposition of a deductible.Section seven amends Insurance Law § 4306-c to require Article 43 corporations and municipal cooperative health benefit plans certified pursuant to Article 47 that utilize a network of providers to provide access to out-of-network services.Section eight amends Insurance Law § 4324 to make the changes outlined in section one of this bill to Article 43 corporations.Section nine amends Insurance Law § 4324 to make the changes outlined in section two of this bill applicable to Article 43 corporations.Section ten amends Insurance Law § 4324 to define the usual and customary cost for purposes of this section.Sections 11, 12, 13, 14 and 15 amend Article 49 of the Insurance Law to establish a procedure for the review and appeal of denials of out-of-network referrals.Section 16 adds Public Health Law § 23-§ 24 requiring physicians to submit a claim form with a patient bill and requiring care professionals and