Prohibits health care plans and health insurers from requiring health care providers to accept products offered by such plan or insurer

2 Co-sponsors

• Suzi Oppenheimer
• Michael H. Ranzenhofer

BILL NUMBER:S3675

Title of bill

An act to amend the public health law and the insurance law, in relation to provisions requiring health care providers to accept the products of a health care plan or insurer

Purpose

To prohibit the use of "all products" clauses which mandate the acceptance of all types of insurance products, even those which the physician believes are inferior and may not serve to protect the patient's health.

Summary of provisions

Section 1 would amend section 4406-c of the Public Health Law to prohibit the use of" all products" clauses which mandate the acceptance of all types of Insurance products, even those which the physician believes are inferior and may not serve to protect the patient's health.

Sections 2 and 3 make the same changes to sections 32l7-b and 4325 of the Insurance Law.

Existing law

There are currently no provisions of law which would accommodate the stated purpose of this bill.

Justification

"All-products" clauses may be used by the HMO industry to gain leverage over physicians and their patients in the contracting arena. Just as Virginia, Maryland and Kentucky have done, this bill would ban the inappropriate use of "all-products" clauses. Some HMOs and other insurers now require physicians to sign "all-products" clauses in their contracts for participation. This means that if a physician agrees to see patients in one of the plan's products lines, she or he must agree to accept patients from all of the plan's products lines, regardless of his or her belief that one or some products are not adequate. This practice is similar to contracts of adhesion and can lead to the movement of patients into lower quality health care settings. Once an insurance plan has secured enough "all-products" signatories, it may then begin to drive patients, through marketing, pricing and enrollment strategies, to those plans that have fewer benefits for the patients and lower rates of reimbursement to the heal care providers. These contract provisions also can allow plans to quickly establish new product lines, despite concerns regarding their adequacy because they do not have to go into the market and induce physicians and other health care providers to sign on to the new product. Questions and decisions of what, if any, products lines a physician may accept should be determined by negotiation between the physician and the plan - not by a provision in a different, unrelated contact.

Legislative history

S.4934 of 2007-2008; S.4613 of 2005-2006; S.2919 of 2003-2004; S.6330 of 2001-2002

Fiscal implications

To be determined.

Effective date

Immediately and shall apply to any contract issued, renewed, modified or amended on or after such date, with provisions.