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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, in relation to requiring health insurers to provide, when liability for a claim is not reasonably clear, the coverage the policyholder or covered person is enrolled in
Purpose
The require plans to clearly identify to a provider the product an individual is enrolled in for health coverage purposes.
Summary of provisions
Section 1 amends subsection (b) of section 3224-a of the Insurance Law to add a new requirement that an insurer identify the specific type of plan or product the policy-holder or covered person is enrolled in.
Section 2 amends subsection (d) of section 3224-a of the Insurance law to define the plans or products that must be identified by the insurer.
Section 3 provides that this act shall take effect July 1, 2017.
Justification
Hospitals and health care providers are currently challenged with identifying which specific health plan a patient is enrolled in. Health plans today offer a wide variety of products, which can make it very difficult to identify what particular health coverage a patient has. There is no requirement for plans to consistently and uniformly identify what particular product an individual in enrolled in.
The current inability to identify these products or the regulatory rules that apply causes providers, regulators, and plans to waste valuable resources appealing, communicating, and replacing claims incorrectly or when it is not necessary. Under the current system, identification of the type of coverage is ultimately made after an appeal is submitted by a patient or a provider and after these resources have already been wasted.
This bill would ensure plans provide necessary at the time the plan makes a payment determination. This will avoid wasting time and energy on filing unnecessary appeals and identify protections available for patients based on their particular coverage by ensuring clear and consistent information about the particular product a patient is enrolled in.
Legislative history
New Bill
Fiscal implications
None
Effective date
July 1, 2017
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.