What's happening
This bill requires insurers to pay ambulatory service reimbursements directly to providers or as two-party checks to both insured and provider, unless proof of payment by the insured is provided.
Why it matters
Reduces the risk of “surprise billing” or disputes. by ensuring that payments for ambulatory (outpatient) services go directly to the provider or require both the patient and provider to endorse the check, making it harder for funds to be misdirected or delayed.
Helps protect providers from non-payment or delayed payment. since insurers would no longer routinely send reimbursements solely to patients, which sometimes left providers chasing patients for payment after services were rendered.
Improves transparency and accountability. in the insurance reimbursement process by requiring proof of payment before allowing reimbursements to go directly to insured individuals, which may reduce fraudulent or duplicate claims.
May streamline administrative processes for both patients and providers,. potentially reducing confusion and paperwork related to insurance payments and clarifying who is responsible for payment at each step.
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Who cares
Insurers
The bill would require reimbursement for ambulatory services to go directly to the provider or through a check naming both the insured and the provider, with an exception for documented payments.
Ambulatory service providers
Providers would receive reimbursement directly or be named alongside the insured on a two-party check, unless the insurer accepts a record showing the insured already paid.
Insured patients
Patients seeking reimbursement solely in their own name would need to furnish a record of payment that satisfies the insurer.
Headline styles
Insurer Rules for Ambulatory Payments
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Held for consideration in insurance
- Referred to insurance
- Referred to insurance
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1528
2017-2018 Regular Sessions
IN ASSEMBLY
January 12, 2017
Introduced by M. of A. CROUCH, HAWLEY, McKEVITT, McLAUGHLIN -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to reimbursement by insurers for ambulatory services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 15 of subsection (l) of section 3221 of the insurance law is amended by adding a new subparagraph (F) to read as follows:
(F) An insurer who issues reimbursement under this paragraph shall submit such payments either directly, to the provider, or if such payments are issued to the insured, then in the form of a two-party check specifying the name of the insured and the provider of ambulatory services; provided, however, if the insured furnishes a record of payment for such services to the insurer, the insurer may, if satisfied by such record, issue reimbursement solely to the insured.
§ 2. Paragraph 24 of subsection (i) of section 3216 of the insurance law is amended by adding a new subparagraph (F) to read as follows:
(F) An insurer who issues reimbursement under this paragraph shall submit such payments either directly, to the provider, or if such payments are issued to the insured, then in the form of a two-party check specifying the name of the insured and the provider of ambulatory services; provided, however, if the insured furnishes a record of payment for such services to the insurer, the insurer may, if satisfied by such record, issue reimbursement solely to the insured.
§ 3. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04363-01-7
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.