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Who cares
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Sponsors
No co-sponsors yet.
History
- Referred to insurance
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 and the public health law, in relation to pre-authorization of care
Purpose or general idea of the bill
This bill requires insurance companies to supply providers with written confirmation of oral approval for services upon an insured, and maintains that such authorization cannot be retroactively denied without evidence of misrepresentation on the part of the provider or the enrollee.
Summary of specific provisions
Section one amends subsection (e) of section 4905 of the insurance law, as added by chapter 705 of the laws of 1996 to require a utilization review agent to immediately corroborate a verbal approval for medical services with written confirmation of the approval. Such written confirmation may be presented through electronic mail, delivered to an address specified by the provider, facsimile transmission to a number specified by the provider, or through a posting on a website accessible to the provider so that the provider may immediately print and retain a hard copy. In the absence of misrepresentation by the provider or the covered patient, the written approval shall be considered prima facie evidence that the services performed by the provider were covered services considered medically necessary. The performance of these services shall not be denied in light of written approval, nor shall timely reimbursement for such services be denied or limited. In cases where actual services rendered differ from those specific services preauthorized or approved due to a rapid change in patient needs, such services shall be presumptively approved, but may be denied on a retrospective basis if such services are determined not to be medically necessary.
Read the full memo (632 words)
Section two amends subdivision (5) of section 4905 of the public health law, as added by chapter 705 of the laws of 1996 to require a utilization review agent to immediately corroborate a verbal approval for medical services with written confirmation of the approval. Such written confirmation may be presented through electronic mail, delivered to an address specified by the provider, facsimile transmission to a number specified by the provider, or through a posting on a website accessible to the provider so that the provider may immediately print and retain a hard copy. In the absence of misrepresentation by the provider or the covered patient, the written approval shall be considered prima facie evidence that the services performed by the provider were covered services considered medically necessary. The performance of these services shall not be denied in light of written approval, nor shall timely reimbursement for such services be denied or limited. In cases where actual services rendered differ from those specific services preauthorized or approved due to a rapid change in patient needs, such services shall be presumptively approved, but may be denied on a retrospective basis if such services are determined not to be medically necessary.
Section three states that this act shall take effect on the sixtieth day after it shall have become law.
Justification
Insurance companies often extend verbal approvals of requests for pre-certification and authorization by health care providers, and then thereafter deny the services once they have been completed. This policy forces patients, physicians and hospitals to absorb costs for services the insurer approved. Verbal approvals should be followed by a hard copy, sent via e-mail or fax, or posted on the insurer's website, so that the health care providers and/or hospitals can print the approval, and that documentation should be prima facie evidence that the services were indeed covered by the carrier absent a misrepresentation by the provider or the patient.
Prior legislative history
2009: A.3163 Referred to Insurance; 2007-2008: A.5207A/S.5316A Referred to Insurance
Fiscal implications
None.
Effective date
This act shall take effect on the sixtieth (60) day after it shall have become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.