Provides that claims for services by specialists may be subject to review by another specialist in the field if they are initially denied by the insurance company; if the expert agrees that the services were medically necessary, then the insurance company must pay the requested claim.
STATE OF NEW YORK
________________________________________________________________________
3429
2009-2010 Regular Sessions
IN ASSEMBLY
January 27, 2009
___________
Introduced by M. of A. BRADLEY, CYMBROWITZ, GALEF, FIELDS, BENEDETTO,
ESPAILLAT, CLARK, PERRY, HOOPER -- Multi-Sponsored by -- M. of A.
COLTON, GREENE, LATIMER, MAYERSOHN, PAULIN, PHEFFER, SCHIMEL -- read
once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to the processing of
certain claims
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The insurance law is amended by adding a new section 3240
2 to read as follows:
3 § 3240. Processing of claims of services rendered by specialists. If
4 a claim for services is denied by an insurance company and those
5 services were provided for by an American Board of Medical Specialties
6 (ABMS) certified specialist, such specialist may opt to have the insur-
7 ance company have the claim for services reviewed by an ABMS certified
8 specialist in the same field. If the reviewing specialist determines
9 that the rendered services were medically necessary, then the insurance
10 company shall grant the claim.
11 § 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03281-01-9
