STATE OF NEW YORK
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10512
IN SENATE
May 15, 2026
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Introduced by Sen. RIVERA -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to payments to medical
services providers
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 3224-a of the insurance law is amended by adding a
2 new subsection (m) to read as follows:
3 (m) Payments to nonparticipating or nonpreferred providers licensed
4 under the public health law or the education law. (1) Whenever an insur-
5 er or an organization, or corporation licensed or certified pursuant to
6 article forty-three or forty-seven of this chapter or article forty-four
7 of the public health law provides that any health care claims submitted
8 under contracts or agreements issued or entered into pursuant to this
9 article or article forty-two, forty-three or forty-seven of this chapter
10 and article forty-four of the public health law are payable to a partic-
11 ipating or preferred provider for services rendered, the insurer, organ-
12 ization, or corporation licensed or certified pursuant to article
13 forty-three or forty-seven of this chapter or article forty-four of the
14 public health law shall be required to pay such benefits either directly
15 to any similarly licensed nonparticipating or nonpreferred provider at
16 the usual and customary charge, which shall not be excessive or unrea-
17 sonable, when the provider has rendered such services, has on file a
18 duly executed assignment of benefits, and has caused notice of such
19 assignment to be given to the insurer, organization, or corporation
20 licensed or certified pursuant to article forty-three or forty-seven of
21 this chapter or article forty-four of the public health law or jointly
22 to such nonparticipating or nonpreferred provider and to the insured,
23 subscriber, or other covered person; provided, however, that in either
24 case the insurer, organization, or corporation licensed or certified
25 pursuant to article forty-three or forty-seven of this chapter or arti-
26 cle forty-four of the public health law shall be required to send such
27 benefit payments directly to the provider who has the assignment on
28 file. When payment is made directly to a provider as authorized by this
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13775-02-6
S. 10512 2
1 section, the insurer, organization, or corporation licensed or certified
2 pursuant to article forty-three or forty-seven of this chapter or arti-
3 cle forty-four of the public health law shall give written notice of
4 such payment to the insured, subscriber, or other covered person.
5 (2) An insurer shall provide reimbursement for those services
6 prescribed by this section at rates negotiated between the insurer and
7 the provider of such services. In the absence of agreed upon rates, an
8 insurer shall pay for such services at the usual and customary charge,
9 which shall not be excessive or unreasonable.
10 (3) A nonparticipating or nonpreferred provider shall not seek advance
11 payment, deposits, or full payment for covered services from an insured,
12 subscriber, or other covered person unless and until the provider has
13 first submitted a claim to the applicable insurer and the claim has been
14 adjudicated. Nothing contained in this section shall be deemed to
15 prohibit the payment of different levels of benefits or from having
16 differences in coinsurance percentages applicable to benefit levels for
17 services provided by participating or preferred providers and nonpartic-
18 ipating or nonpreferred providers.
19 § 2. This act shall take effect January 1, 2027 and shall apply to
20 health care claims submitted for payment after such date.
