Bill Text: NY S07159 | 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 12-0)

Status: (Engrossed - Dead) 2020-07-22 - referred to insurance [S07159 Detail]

Download: New_York-2019-S07159-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          7159

                    IN SENATE

                                     January 9, 2020
                                       ___________

        Introduced  by Sens. JACKSON, BENJAMIN, CARLUCCI, RAMOS, SALAZAR -- 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 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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14595-01-9
        S. 7159                             2

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