Directs health insurers to provide enrollees the option to assign the payment of emergency services benefits directly to an out of network health care provider

Title of bill

An act to amend the insurance law, in relation to requiring health insurers to provide insureds and covered persons the option to assign the payment of emergency services benefits directly to an out of network health care provider

Purpose

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To ensure payment is made directly to the out-of-network emergency health care provider when the covered individual has assigned benefits for the services rendered.

Summary of provisions

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This act will amend subsection (c) of section 3241 of the Insurance Law to add a new requirement that an insurer that provides benefits to a subscriber under a contract or policy that provides for emergency services provide the subscriber the option of assigning the payment of any benefits to out-of-network health care providers and that the insurer shall make such payment directly to the out-of-network healthcare provider.

Section three provides that this act shall take effect 90 days after enactment.

Justification

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Either before or after accessing health care services, most consumers sign written consent forms authorizing providers to bill their insurance companies for the services they provide and assigning any payment due for those services directly to the provider. This relieves consumers of the burden of filing claims, chasing reimbursement and remitting payment to providers which can be a complex process and particularly difficult when the consumer is unwell and undergoing treatment. However, some insurers prohibit consumers from assigning benefits for services they receive from providers that do not participate in the insurer's network. This is a particular problem when consumers receive emergency services from out-of-network providers. In emergency situations consumers are not always able to access in-network providers and hospitals must treat all patients in need of emergency care regardless of whether they participate in the consumer's insurance plan. In these situations, if the insurer does not permit the patient to assign their insurance benefits, the patient is put in the middle between the insurer and the provider.

With insurers increasingly narrowing provider networks, it is becoming more common for hospitals to be out-of-network with some insurers. There have been recent instances of a major insurer issuing all out-of-network emergency payments to the patient or subscriber, even where the subscriber has signed an assignment of benefits. This has confused and upset patients as providers have been forced to bill them for services in order to get paid. It has also increased administrative work for hospitals and negatively impacted cash flow. This legislation would amend the Insurance Law to require insurers to give subscribers the option to assign benefits for out-of-network emergency services to the provider and to ensure that when benefits have been assigned, payment is issued directly to the provider.

Legislative history

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New bill.

Fiscal implications

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None. EFFECTIVE DATE: :

90 days after enactment.