STATE OF NEW YORK ________________________________________________________________________ 9077 IN SENATE June 15, 2018 ___________ Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the insurance law, in relation to patient billing for emergency services The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subsection (c) of section 3241 of the insurance law, as 2 added by section 6 of part H of chapter 60 of the laws of 2014, is 3 amended to read as follows: 4 (c) (1) When an insured or enrollee under a contract or policy that 5 provides coverage for emergency services receives the services from a 6 health care provider that does not participate in the provider network 7 of an insurer, a corporation organized pursuant to article forty-three 8 of this chapter, a municipal cooperative health benefit plan certified 9 pursuant to article forty-seven of this chapter, a health maintenance 10 organization certified pursuant to article forty-four of the public 11 health law, or a student health plan established or maintained pursuant 12 to section one thousand one hundred twenty-four of this chapter ("health 13 care plan"), the health care plan shall: (A) ensure that the insured or 14 enrollee shall incur no greater out-of-pocket costs for the emergency 15 services than the insured or enrollee would have incurred with a health 16 care provider that participates in the health care plan's provider 17 network; and (B) provide the insured or enrollee the option of assigning 18 the payment of any benefits due under such contract or policy directly 19 to the health care provider. Whenever, in any health insurance claims 20 form, an insured or enrollee specifically authorizes the payment of 21 benefits directly to a health care provider, the health care provider 22 shall submit claims for benefits to the health care plan and the health 23 care plan shall make payment for any benefits to the health care provid- 24 er. 25 (2) Whenever an insured or enrollee specifically authorizes the 26 payment of benefits directly to a health care provider, the health care 27 provider shall not bill the insured or enrollee for payment of any EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD16065-02-8

S. 9077 2 1 amount other than any applicable copayment, coinsurance and/or deduct- 2 ible unless the health plan fails to honor an assignment of benefits. 3 (3) The health care provider shall not further bill the insured or 4 enrollee for any remaining balance once the health care plan has made 5 its initial payment for which the insured or enrollee must be held harm- 6 less by the health plan, but shall, with notice to the insured or enrol- 7 lee of the existing balance, resubmit the balance to the health plan. In 8 the event an insured or enrollee mistakenly reimburses a health care 9 provider for emergency services for which the insured or enrollee has 10 assigned payment of benefits pursuant to paragraph one of this 11 subsection, the health care provider shall promptly refund such payment, 12 less any applicable copayment, coinsurance and/or deductible, to the 13 insured or enrollee. 14 For the purpose of this section, "emergency services" shall have the 15 meaning set forth in subparagraph (D) of paragraph nine of subsection 16 (i) of section three thousand two hundred sixteen of this article, 17 subparagraph (D) of paragraph four of subsection (k) of section three 18 thousand two hundred twenty-one of this article, and subparagraph (D) of 19 paragraph two of subsection (a) of section four thousand three hundred 20 three of this chapter. 21 § 2. This act shall take effect on the ninetieth day after it shall 22 have become a law.

Relates to patient billing for emergency services

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