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.
STATE OF NEW YORK
________________________________________________________________________
3526
2015-2016 Regular Sessions
IN ASSEMBLY
January 23, 2015
___________
Introduced by M. of A. TITONE, STECK, MONTESANO, BROOK-KRASNY, HOOPER,
PERRY, SALADINO -- Multi-Sponsored by -- M. of A. McDONOUGH, SIMANOW-
ITZ, WRIGHT -- 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 § 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 § 3. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03802-01-5
