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Sponsors
1 Co-sponsor
History
- Referred to insurance
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.
Regulates the payment of reimbursement where the insured has assigned his or her rights to an out-of-plan health care provider
In Assembly Committee · Insurance · Sponsor Richard Gottfried
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:S6565
Title of bill
An act to amend the insurance law, in relation to assignment of rights by the insured
Purpose or general idea of bill
To improve managed care market conduct and to clarify that consumers have the option to authorize direct reimbursement from their insurer to their out-of-network provider.
Summary of provisions
Section one adds a §3216(i)(29) to the Insurance Law, Section two adds a §3221(s) to the Insurance Law and section three adds a §4303(a-1) to the Insurance Law.
These sections require that insurers allow consumers to have the option to authorize direct reimbursement from their insurer to their out-of-network provider.
Section four provides that the act shall take effect on January 1st next succeeding the date on which it shall become law.
Justification
A new managed care practice is emerging where health insurers are prohibiting consumers from authorizing direct reimbursement from their insurer to their out-of-network provider. The reason, the plans say, is the need to educate consumers about the true cost of their health care. The clear and objectionable result, is yet another collection problem for providers who are already feeling the strain of limited resources. The not-so-subtle message to providers is to stay in a plan's network regardless of the inadequacy of compensation. This bill would clarify that consumers have the option to authorize direct reimbursement from their insurer to their out-of-network provider.
Dominant health plans with major market shares in their region have considerable leverage to dictate terms and rates to providers. This imbalance is made worse by anti-trust limitations that prevent providers from negotiating in any manner that would somewhat level the disparity of power between the parties. Even worse, the growing number of practices, like the one this bill is proposed to prohibit, designed to discourage members from using their benefits and/or prevent providers from dropping out of the plan's network despite the inadequacy of reimbursement.
Prior legislative history
2007-2008 - S.5231 Died in Insurance.
Fiscal implications
None.
Effective date
January 1, 2013
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.