Bill Text: NY A02843 | 2011-2012 | General Assembly | Introduced

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Bill Title: Directs health maintenance organization which denies claim due to absence of medical necessity to inform insured as to preferred alternative treatment, or provide the insured with a statement as to the past ineffectiveness of the requested procedure or treatment.

Spectrum: Partisan Bill (Democrat 20-0)

Status: (Introduced - Dead) 2012-01-04 - referred to insurance [A02843 Detail]

Download: New_York-2011-A02843-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         2843
                              2011-2012 Regular Sessions
                                 I N  A S S E M B L Y
                                   January 20, 2011
                                      ___________
       Introduced  by  M. of A. PRETLOW, PHEFFER -- Multi-Sponsored by -- M. of
         A. AUBRY, CAHILL, CANESTRARI, CLARK, COLTON, COOK, CUSICK, CYMBROWITZ,
         ENGLEBRIGHT, FARRELL,  GLICK,  HIKIND,  MAYERSOHN,  McENENY,  MILLMAN,
         NOLAN,  ORTIZ,  SCARBOROUGH -- read once and referred to the Committee
         on Insurance
       AN ACT to amend the insurance law, in relation to notice by health main-
         tenance organizations that a request  for  coverage  of  a  particular
         treatment is denied
         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 2601-a
    2  to read as follows:
    3    S 2601-A. DENIAL OF COVERAGE OR  TREATMENT  BY  A  HEALTH  MAINTENANCE
    4  ORGANIZATION. WHENEVER A HEALTH MAINTENANCE ORGANIZATION, DOING BUSINESS
    5  IN  THIS STATE, DENIES A CLAIM FOR COVERAGE OF A PARTICULAR PROCEDURE OR
    6  TREATMENT BECAUSE SUCH PROCEDURE OR TREATMENT IS  NOT  MEDICALLY  NECES-
    7  SARY, THE HEALTH MAINTENANCE ORGANIZATION SHALL INFORM THE INSURED AS TO
    8  THOSE  PREFERRED  PROCEDURE OR TREATMENT OPTIONS WHICH WOULD BE COVERED,
    9  OR PROVIDE THE INSURED WITH A STATEMENT AS TO THE  PAST  INEFFECTIVENESS
   10  OF THE REQUESTED PROCEDURE OR TREATMENT.
   11    S  2.  This  act shall take effect on the thirtieth day after it shall
   12  have become a law.
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02770-01-1