Bill Text: NY A09085 | 2019-2020 | General Assembly | Introduced

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Bill Title: Requires specification between partial approval of medical claims or payments and full denial of medical claims or payments on written notices to an insurer or an organization or corporation licensed or certified.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2020-01-17 - referred to insurance [A09085 Detail]

Download: New_York-2019-A09085-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          9085

                   IN ASSEMBLY

                                    January 17, 2020
                                       ___________

        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
          Committee on Insurance

        AN ACT to amend the insurance law, in relation to  requiring  specifica-
          tion  between  partial  approval  of  medical  claims  and a denial of
          medical claims on written notices to an insurer

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Subsection (b) of section 3224-a of the insurance law, as
     2  amended by chapter 237 of the laws  of  2009,  is  amended  to  read  as
     3  follows:
     4    (b) In a case where the obligation of an insurer or an organization or
     5  corporation  licensed  or  certified  pursuant to article forty-three or
     6  forty-seven of this chapter or article forty-four of the  public  health
     7  law  to  pay a claim or make a payment for health care services rendered
     8  is not reasonably clear due to a good faith dispute regarding the eligi-
     9  bility of a person for coverage, the liability  of  another  insurer  or
    10  corporation  or organization for all or part of the claim, the amount of
    11  the claim, the benefits covered under a contract or  agreement,  or  the
    12  manner in which services were accessed or provided, an insurer or organ-
    13  ization  or corporation shall pay any undisputed portion of the claim in
    14  accordance with this subsection and  notify  the  policyholder,  covered
    15  person or health care provider in writing within thirty calendar days of
    16  the receipt of the claim:
    17    (1) whether the claim or bill has been denied or partially approved;
    18    (2)  which  claim  or  medical payment that it is not obligated to pay
    19  [the claim or make the medical payment,] stating  the  specific  reasons
    20  why it is not liable; [or
    21    (2)] and
    22    (3)  to request all additional information needed to determine liabil-
    23  ity to pay the claim or make the health care payment.
    24    Upon receipt of the information requested in paragraph [two] three  of
    25  this subsection or an appeal of a claim or bill for health care services
    26  denied  pursuant  to  [paragraph  one of] this subsection, an insurer or
    27  organization or corporation licensed or certified  pursuant  to  article

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14595-01-9
        A. 9085                             2

     1  forty-three  or forty-seven of this chapter or article forty-four of the
     2  public health law shall comply with subsection (a) of this section.  Any
     3  denial  or partial approval of claim or payment and the specific reasons
     4  for such denial or partial approval pursuant to this subsection shall be
     5  prominently  displayed  on  a  written notice with at least twelve-point
     6  type. A partial approval of claim or payment shall state at the  top  of
     7  such  written  notice with at least fourteen-point type bold: "NOTICE OF
     8  PARTIAL APPROVAL OF MEDICAL COVERAGE". A  denial  of  claim  or  payment
     9  shall  state  at  the top of such written notice with at least fourteen-
    10  point type bold: "NOTICE OF DENIAL OF MEDICAL COVERAGE". Any  additional
    11  terms  or conditions included on such notice of partial approval or such
    12  notice of denial, such as but not limited to time restraints to file  an
    13  appeal, shall be included with at least twelve-point type.
    14    §  2.  This  act shall take effect on the ninetieth day after it shall
    15  have become a law and shall apply  to  policies  and  contracts  issued,
    16  renewed, modified, altered or amended on or after such effective date.