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A08687 Summary:

BILL NO    A08687 

SAME AS    No same as 

SPONSOR    Titone

COSPNSR    Steck, Montesano, Brook-Krasny, Hooper, Perry, Saladino

MLTSPNSR   McDonough, Simanowitz, Wright

Amd SS3216 & 3221, Ins L

Requires notification to insureds that an out-of-network physician may be used
in their procedure, test or surgery and such physician's services shall not be
covered by their insurance policy; requires such services must be covered if
the insured person does not receive notification prior to such services or
procedure.
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A08687 Text:

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

                                         8687

                                 I N  A S S E M B L Y

                                   February 3, 2014
                                      ___________

       Introduced by M. of A. TITONE -- read once and referred to the Committee
         on Insurance

       AN ACT to amend the insurance law, in relation to requiring notification
         to  insured  persons  that  an out-of-network physician may be used in
         their procedure, test or surgery

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

    1    Section  1.  Section  3216 of the insurance law is amended by adding a
    2  new subsection (n) to read as follows:
    3    (N) (1) EVERY PERSON INSURED UNDER A POLICY  OF  ACCIDENT  AND  HEALTH
    4  INSURANCE  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE ENTI-
    5  TLED TO NOTIFICATION FROM THE BILLING ENTITY  PRIOR  TO  THE  PROCEDURE,
    6  TEST  OR  SURGERY,  THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE USED IN SUCH
    7  PROCEDURE, TEST OR SURGERY AND SUCH PHYSICIAN'S SERVICES  SHALL  NOT  BE
    8  COVERED BY THEIR INSURANCE POLICY.
    9    (2)  THE  PATIENT  COSTS OF OUT-OF-NETWORK PHYSICIAN SERVICES SHALL BE
   10  COVERED BY THE INSURANCE POLICY OF AN INSURED PERSON IF HE  OR  SHE  HAS
   11  NOT  RECEIVED  NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO THE HEALTH
   12  SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
   13    S 2. Section 3221 of the insurance law is  amended  by  adding  a  new
   14  subsection (t) to read as follows:
   15    (T)  (1)  EVERY  PERSON  INSURED UNDER A POLICY OF ACCIDENT AND HEALTH
   16  INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE  ENTI-
   17  TLED  TO  NOTIFICATION  FROM  THE BILLING ENTITY PRIOR TO THE PROCEDURE,
   18  TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE  USED  IN  SUCH
   19  PROCEDURE,  TEST  OR  SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE
   20  COVERED BY THEIR INSURANCE POLICY.
   21    (2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN  SERVICES  SHALL  BE
   22  COVERED  BY  THE  INSURANCE POLICY OF AN INSURED PERSON IF HE OR SHE HAS
   23  NOT RECEIVED NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO  THE  HEALTH
   24  SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
   25    S 3. This act shall take effect immediately.

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD13209-01-3
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