Prevents health plans from engaging in overpayment recovery efforts that include contacting the patient to seek reimbursement for such overpayment of claims.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1663
SPONSOR: Rosenthal L TITLE OF BILL:
An act to amend the insurance law, in relation to overpayment of insur-
ance claims
PURPOSE:
This bill would prevent insurance companies from engaging in overpayment
recovery efforts that include contacting the patient to seek reimburse-
ment for overpayment claims
SUMMARY OF SPECIFIC PROVISIONS:
Section one of the bill amends section 3224-b of the insurance law.
Section two establishes the effective date.
JUSTIFICATION:
Billing disputes between healthcare providers and insurance companies
are common, and often occur when a patient undergoes an expensive
medical procedure. After patients have satisfied their financial obli-
gations as required by their insurance plan, patients should no longer
be involved in such disputes. Despite this, doctors' offices and hospi-
tals regularly send collection notices to patients for bills that the
insurance company, and not the patient, is responsible for covering. The
collection notices are weaponized by both parties; some incorrectly
claim that the patient is responsible to cover the outstanding balance
hoping that the patient will step in to help resolve the dispute.
After a patient's financial responsibility is fulfilled, their primary
responsibility should be healing, not resolving disputes between well-
paid insurers and hospitals or other medical providers. In September
2021, the New York Times published the story of Clayton and Brittany
Giroux Lane, who in 2018, gave birth to their daughter Alexandra. Unfor-
tunately, Alexandra's health quickly declined, and she passed away 25
days later.
In 2021, the Lanes began receiving debt collection notices for hospital
bills totaling over $250,000. In response, the couple sent dozens of
emails, spent hours on the phone and filed regulatory complaints in two
states. Not only was this shocking and extremely concerning for the
Lanes financially, but it forced them to continuously relive the experi-
ence of losing their daughter.
Both the Lanes' insurance company, Cigna, and healthcare provider, Mount
Sinai West, have publicly acknowledged that the Lanes were not responsi-
ble for payment, but the issue had still not been resolved by the time
their story was ran by the New York Times. Mount Sinai agreed to issue a
statement on letterhead indicating that the family was not responsible
for these payments.
Not only is it inappropriate for insurers to renege on their responsi-
bility to cover patients based on their health plans, but it is morally
corrupt for such large corporations to pursue individuals for payments
that they are contractually not responsible. This legislation would
prevent insurance companies from pursuing patients to seek reimbursement
for these claims.
LEGISLATIVE HISTORY:
2021-22: A.8885 - Referred to Insurance
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This bill shall take on the ninetieth day after it shall have become a
law.
STATE OF NEW YORK
________________________________________________________________________
1663
2023-2024 Regular Sessions
IN ASSEMBLY
January 17, 2023
___________
Introduced by M. of A. L. ROSENTHAL -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to overpayment of insur-
ance claims
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 1 of subsection (b) of section 3224-b of the
2 insurance law, as amended by chapter 237 of the laws of 2009, is amended
3 to read as follows:
4 (1) Other than recovery for duplicate payments, a health plan shall
5 provide thirty days written notice to health care providers before
6 engaging in additional overpayment recovery efforts seeking recovery of
7 the overpayment of claims to such health care providers. Such notice
8 shall state the patient name, service date, payment amount, proposed
9 adjustment, and a reasonably specific explanation of the proposed
10 adjustment. A health plan shall not engage in any overpayment recovery
11 efforts that include contacting the patient to seek reimbursement for
12 such overpayment of claims.
13 § 2. This act shall take effect on the ninetieth day after it shall
14 have become a law and shall apply to policies and contracts issued,
15 renewed, modified, altered or amended on or after such effective date.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05770-01-3
