STATE OF NEW YORK
________________________________________________________________________
10317
IN SENATE
May 13, 2026
___________
Introduced by Sen. JACKSON -- read twice and ordered printed, and when
printed to be committed to the Committee on Health
AN ACT to amend the public health law and the insurance law, in relation
to network participation verification and disclosure
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Legislative findings and intent. The legislature finds that
2 patients routinely rely on representations by health care providers
3 regarding participation in a health plan's network. Providers frequently
4 state they are "in-network" based on outdated or incomplete information,
5 resulting in unexpected out-of-network charges and financial harm.
6 Existing law requires insurers to maintain accurate provider directories
7 but imposes no corresponding duty on providers to verify their contrac-
8 tual status prior to communicating with patients. This act establishes a
9 clear, enforceable requirement for real-time verification and disclo-
10 sure, and provides consumer protections when such verification does not
11 occur.
12 § 2. The public health law is amended by adding a new section 25 to
13 read as follows:
14 § 25. Network participation verification and disclosure. 1. Defi-
15 nitions. For purposes of this section:
16 (a) "Health care provider" means any individual or entity licensed,
17 certified or authorized to provide health care services in this state.
18 (b) "Insurer" means any insurer, health maintenance organization, or
19 health benefit plan subject to the insurance law or this chapter.
20 (c) "Network participation status" means whether a provider is
21 contracted as a participating provider under a specific health benefit
22 plan.
23 (d) "Real-time verification" means an electronic or telephonic confir-
24 mation obtained directly from the insurer or its designated verification
25 system within the preceding seventy-two hours.
26 2. Verification requirement. No health care provider, or employee or
27 agent thereof shall represent, state, imply or confirm to a patient or
28 prospective patient that the provider is in-network, participating, or
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15153-01-6
S. 10317 2
1 otherwise contracted with a health plan unless real-time verification of
2 network participation status has been completed.
3 3. Pre-service documentation and disclosure. (a) Prior to scheduling
4 an appointment or rendering any non-emergency service, a provider shall
5 furnish the patient with written or electronic documentation stating:
6 (i) that real-time verification was completed; and
7 (ii) whether the provider is in-network or out-of-network for the
8 patient's specific health plan.
9 (b) If the provider is out-of-network, the documentation shall state
10 that services will be billed at out-of-network rates and may result in
11 higher out-of-pocket costs.
12 (c) Documentation shall be acknowledged by the patient prior to
13 service.
14 4. Documentation retention. (a) If the patient is billed at the
15 in-network rate or lower, the provider shall not be required to retain
16 or produce proof of real-time verification.
17 (b) If the patient is billed at out-of-network rates, the provider
18 shall retain all verification and disclosure documentation for three
19 years from the date of service.
20 (c) Proof of real-time verification shall be required only when the
21 provider bills out-of-network.
22 5. Penalty for failure to disclose. (a) A provider that fails to
23 comply with subdivisions two or three of this section shall be prohibit-
24 ed from billing, collecting or attempting to collect from the patient
25 any amount other than the in-network copayment applicable under the
26 patient's health plan.
27 (b) Where a claim is made pursuant to paragraph (a) of this subdivi-
28 sion, the insurer shall process the claim as if the provider were
29 in-network, and the provider shall accept the in-network allowed amount
30 as payment in full.
31 (c) Any attempt to bill a patient in violation of this subdivision
32 shall constitute a deceptive business practice under section three
33 hundred forty-nine of the general business law.
34 § 3. The insurance law is amended by adding a new section 3217-k to
35 read as follows:
36 § 3217-k. Verification systems. 1. Every insurer shall maintain a
37 real-time verification system accessible to providers at no cost.
38 2. Insurers shall issue a confirmation number or electronic record for
39 each verification.
40 3. Insurers shall be bound by any verification issued unless obtained
41 through fraud or misrepresentation.
42 § 4. The insurance law is amended by adding a new section 4306-j to
43 read as follows:
44 § 4306-j. Verification systems. 1. Every corporation shall maintain a
45 real-time verification system accessible to providers at no cost.
46 2. Corporations shall issue a confirmation number or electronic record
47 for each verification.
48 3. Corporations shall be bound by any verification issued unless
49 obtained through fraud or misrepresentation.
50 § 5. The public health law is amended by adding a new section 4406-j
51 to read as follows:
52 § 4406-j. Verification systems. 1. Every health maintenance organiza-
53 tion shall maintain a real-time verification system accessible to
54 providers at no cost.
55 2. Health maintenance organizations shall issue a confirmation number
56 or electronic record for each verification.
S. 10317 3
1 3. Health maintenance organizations shall be bound by any verification
2 issued unless obtained through fraud or misrepresentation.
3 § 6. This act shall take effect on the one hundred eightieth day after
4 it shall have become a law. Effective immediately, the addition, amend-
5 ment and/or repeal of any rule or regulation necessary for the implemen-
6 tation of this act on its effective date are authorized to be made and
7 completed on or before such effective date.
