What's happening
This bill limits health insurers' ability to deny payment for certain treatments given alongside pre-authorized care unless specific exceptions apply.
Why it matters
Protects patients from unexpected insurance denials. by making it harder for insurers to refuse payment for treatments addressing symptoms or side effects that occur during approved care, unless those treatments clearly fall under specific exceptions.
Shifts the burden to insurers on appeal. If payment is denied due to lack of pre-authorization, insurers must prove the treatment is not covered, not medically necessary, experimental, or falls under other pre-defined exceptions—potentially reducing administrative denials for routine, supportive care.
Improves continuity of care. By limiting denials for treatments administered at the same time as pre-authorized services, patients are less likely to face gaps or delays in managing side effects, which can be crucial for complex or ongoing medical conditions.
May influence insurer practices and patient-provider interactions. Insurers may need to adjust internal processes and providers may feel more confident in delivering comprehensive care without fear of retroactive financial penalties for treating side effects.
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Who cares
Headline styles
Stop Surprise Health Coverage Denials
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Delivered to senate
- Passed assembly
- Ordered to third reading cal.77
- Returned to assembly
- Died in senate
- Referred to insurance
- Delivered to senate
- Passed assembly
- Advanced to third reading cal.7
- Reported
- 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.
Stop Coverage Denial After Approval
In Senate Committee · Insurance · Sponsor Kemp Hannon
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1129
2017-2018 Regular Sessions
IN ASSEMBLY
January 10, 2017
Introduced by M. of A. HUNTER -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to denial of coverage of treatment related to health care services for which pre-authorization was granted
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3238 of the insurance law is amended by adding a new subsection (c-1) to read as follows:
(c-1) If a health plan denies payment for the treatment of concurrent symptoms or side effects due to lack of pre-authorization and such treatment is rendered at the same time as a health care service for which pre-authorization was required and received, upon the appeal of the denial, the denial of any such service shall be upheld only if it is determined that:
(1) the treatment is not a covered benefit;
(2) the treatment was not medically necessary pursuant to section four thousand nine hundred four of this chapter or section forty-nine hundred four of the public health law;
(3) the treatment was experimental or investigational pursuant to section four thousand nine hundred four of this chapter or section forty-nine hundred four of the public health law; or
(4) one of the conditions set forth in paragraphs one through six of subsection (a) of this section is met.
§ 2. This act shall take effect on the ninetieth day after it shall have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02613-01-7
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.