Bill Text: NY S02008 | 2021-2022 | General Assembly | Amended

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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 10-0)

Status: (Passed) 2021-12-21 - SIGNED CHAP.694 [S02008 Detail]

Download: New_York-2021-S02008-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         2008--B
            Cal. No. 570

                               2021-2022 Regular Sessions

                    IN SENATE

                                    January 16, 2021
                                       ___________

        Introduced   by   Sens.   JACKSON,  BENJAMIN,  RAMOS,  SALAZAR,  BIAGGI,
          GOUNARDES, KRUEGER, LIU, RIVERA, SEPULVEDA -- read twice  and  ordered
          printed,  and  when printed to be committed to the Committee on Insur-
          ance -- reported favorably from said committee, ordered to  first  and
          second report, ordered to a third reading, passed by Senate and deliv-
          ered  to  the Assembly, recalled, vote reconsidered, restored to third
          reading, amended and ordered reprinted, retaining  its  place  in  the
          order  of  third  reading  --  repassed by Senate and delivered to the
          Assembly, recalled, vote  reconsidered,  restored  to  third  reading,
          amended  and  ordered  reprinted,  retaining its place in the order of
          third reading

        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 section 8 of part YY of chapter 56 of the laws  of  2020,  is
     3  amended to read as 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, and through the internet or

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00505-05-1
        S. 2008--B                          2

     1  other electronic means for claims submitted in that manner, within thir-
     2  ty calendar days of the receipt of the claim:
     3    (1) whether the claim or bill has been denied or partially approved;
     4    (2)  which  claim  or  medical payment that it is not obligated to pay
     5  [the claim or make the medical payment,] stating  the  specific  reasons
     6  why it is not liable; [or
     7    (2)] and
     8    (3)  to request all additional information needed to determine liabil-
     9  ity to pay the claim or make the health care payment; and
    10    [(3)] (4) of the specific type of plan or product the policyholder  or
    11  covered  person  is  enrolled  in; provided that nothing in this section
    12  shall authorize discrimination based on the source of payment.
    13    Upon receipt of the information requested in paragraph [two] three  of
    14  this subsection or an appeal of a claim or bill for health care services
    15  denied  pursuant  to  [paragraph  one of] this subsection, an insurer or
    16  organization or corporation licensed or certified  pursuant  to  article
    17  forty-three  or forty-seven of this chapter or article forty-four of the
    18  public health law shall comply with  subsection  (a)  of  this  section;
    19  provided, that if the insurer or organization or corporation licensed or
    20  certified pursuant to article forty-three or forty-seven of this chapter
    21  or  article  forty-four of the public health law determines that payment
    22  or additional payment is due on the claim, such payment shall be made to
    23  the policyholder or  covered  person  or  health  care  provider  within
    24  fifteen  days  of the determination.   Any denial or partial approval of
    25  claim or payment and the specific reasons for  such  denial  or  partial
    26  approval pursuant to this subsection shall be prominently displayed on a
    27  written  notice  with  at least twelve-point type. A partial approval of
    28  claim or payment shall state at the top of such written notice  with  at
    29  least  fourteen-point  type bold: "NOTICE OF PARTIAL APPROVAL OF MEDICAL
    30  COVERAGE". A denial of claim or payment shall state at the top  of  such
    31  written notice with at least fourteen-point type bold: "NOTICE OF DENIAL
    32  OF  MEDICAL  COVERAGE".  Any  additional terms or conditions included on
    33  such notice of partial approval or such notice of denial,  such  as  but
    34  not limited to time restraints to file an appeal, shall be included with
    35  at least twelve-point type.
    36    §  2.  This  act shall take effect on the ninetieth day after it shall
    37  have become a law and shall apply  to  policies  and  contracts  issued,
    38  renewed, modified, altered or amended on or after such effective date.