Requires insurance providers to remove the names of any non-participating physicians from their website

Section two amends Paragraph 17 of subsection (a) of section 4324 of the Insurance Law by requiring that where a health service, hospital service or medical indemnity corporation elects to post information on its website regarding participating health care providers, such corporation shall remove any non-participating provider from its website within thirty (30) calendar days from either the date when the provider has notified the corporation, in writing, that s/he will no longer participate with the corporation, or the date the contractual agreement between the corporation and the provider ceases to be in effect. provisions shall be included in contracts between health care providers and such corporations providing that when the corporation fails to remove a non-participating health care provider from its website within such thirty (30) day period, the corporation shall be liable for out-of-network rates for services rendered by a nonparticipating provider to a subscriber of the corporation from the date such non-participating health care provider should have been removed to the date that such non-participating health care provider is, in fact, removed. Such contract provision shall also provide that such out-of-network payment shall not be reduced by any applicable co-payment or deductible and shall include express provisions indicating that the corporation shall hold subscribers harmless from liability and shall not bill subscribers under any circumstances for the costs of covered services rendered by the contracting health care provider.

Section three amends Paragraph (r) of subdivision 1 of section 4408 of the Public Health Law by requiring that where a health maintenance organization (HMO) elects to post information on its website regarding participating health care providers, such HMO shall remove any nonparticipating provider from its website within thirty (30) calendar days from either the date when the provider has notified the HMO, in writing, that s/he will no longer participate with the HMO, or the date the contractual agreement between the HMO and the provider ceases to be in effect. provisions shall be included in contracts between health care providers and HMOs providing that when the HMO fails to remove a nonparticipating health care provider from its website within such thirty (30) day period, the HMO shall be liable for out-of-network rates for services rendered by a non-participating provider to an enrollee of the HMO from the date such non-participating health care provider should have been removed to the date that such non participating health care provider is, in fact, removed. Such contract provision shall also provide that such out-of-network payment shall not be reduced by any applicable co-payment or deductible and shall include express provisions indicating that the HMO shall hold enrollees harmless from liability and shall not bill enrollees under any circumstances for the costs of covered services rendered by the contracting health care provider.

Section four provides the effective date.

Effects of present law which the bill will alter

This bill amends the Insurance Law and the Public Health Law by requiring insurance providers that provide a list of participating physicians on their website to maintain accurate and up-to-date listings of participating physicians by mandating that the names of non-participating physicians be removed from the website within thirty (30) days from the date the physician no longer participates. In addition, the bill makes any insurance provider who fails to comply with the provisions of this legislation liable for the out-of-network cost of any services provided by the physician to the patient.

Justification

Patients frequently utilize the websites of their insurance providers, HMOs, and health service, hospital service or medical indemnity corporations to find physicians participating in their insurance plans. Failure to maintain accurate lists of participating physicians can lead to patients seeking medical services from a non-participating physician without knowing they are so doing. This bill ensures that insurance providers that maintain lists of participating physicians on their websites do so in an accurate and up-to-date fashion. Insurance providers who violate the provisions of this bill will be liable for the out-of-network cost of any services provided by non-participating physicians whose names are still on the insurance provider's website more than thirty (30) days after written notice of such non participation, or the expiration of the contract between the health care provider and the insurance provider. This legislation guarantees swift adherence to the requirements of this legislation.

Prior legislative history

A.9658 of 2005-06 A.3094/S.5413 of 2007-08

Fiscal implications for state and local governments

None.

Effective date

This act shall take effect on the first of January next succeeding the date on which it shall have become law and shall apply to all contracts issued, renewed, modified or altered on or after such effective date.