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Who cares
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Sponsors
No co-sponsors yet.
History
- Print number 6189a
- Amend (t) and recommit to insurance
- Referred to insurance
- Referred to rules
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Relates to insurer recovery from health care providers
In Assembly Committee · Insurance · Sponsor Richard Gottfried
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to insurer recovery from health care providers
Purpose of bill
This bill eliminates the definition of the term abusive billing as it relates to an insurers' ability to look back at past billing practices. Further it should help to enable fair and equitable resolution of allegations by insurers that a health care provider has been overpaid for past benefit claims.
Summary of specific provisions
Section 1: Amends Insurance Law section 3224-b to remove the term "abusive billing" from the law. This provision relates to an insurers' ability to demand repayment from a health care provider on a bill that was paid for medical care by an insurer over 24 months before the overpayment recovery efforts were initiated by the insurer against the health care provider.
This bill also reduces the look back period of time from 24 months to 12 months and adds a new paragraphs 6 and 7 to provide further safeguards to protect health care providers when being audited by an insurer for fraud or inappropriate billings.
Section 2: Effective Date.
Justification
This bill eliminates the term defined in the law "abusive billing" as a basis for insurers and HMOs to initiate such billing overpayment recovery efforts that are more than 24 months (and under this bill only after 12 months) .after the original payment was received by the provider. The existing definition of "abusive billing" is both subjective and vague to the point that it invites confusion rather than clarity in settling health care provider invoices.
As a result of this ambiguity, it has become a common, but controversial practice, for insurers and HMOs to exploit this subjective term to justify circumventing the statutory two-year look back limitation on overpayment recoveries. In some instances, health plans have used the practice of extrapolation of a relatively few claims to determine overpayment amounts that can stretch into tens of thousands of dollars. contesting a refund demand is difficult and can be expensive for the health care provider, hence many providers are intimidated into settling the dispute.
Legislative history
New bill.
Fiscal implications
None to the state.
Effective date
Immediate.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.