What's happening
This bill requires health insurance policies to cover clinical laboratory services at out-of-network labs if directed by an in-network provider.
Why it matters
Reduces surprise billing. By requiring insurance coverage for lab work at out-of-network labs when directed by an in-network provider, this bill helps patients avoid unexpected and often costly medical bills for necessary tests.
Supports provider decision-making. Ensures that in-network healthcare providers can send specimens to the labs they deem most appropriate for a patient’s care, without being limited by insurance network restrictions.
Expands patient access to lab services. Patients are less likely to face delays or barriers to critical diagnostic tests, as registered out-of-network labs cannot be excluded if they meet policy standards.
Promotes fairness among laboratories. Out-of-network labs can provide services as long as they agree to the same minimum standards and conditions as in-network labs, potentially fostering competition and improving service quality.
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Who cares
Insured patients
The bill would bar limiting or denying reimbursement solely because a laboratory is out of network when an in-network provider sends their specimens there or directs them there for testing.
Health insurers and third-party benefit programs
The bill would restrict out-of-network laboratory reimbursement exclusions and prohibit excluding duly registered laboratories that agree to meet their minimum standards and conditions for similar providers.
Clinical laboratories
Duly registered laboratories would gain protection against exclusion if they agree to meet the policy’s standards, while out-of-network laboratories would benefit from reimbursement protections for provider-directed testing.
In-network health care providers
Their decisions to send collected specimens or direct patients to out-of-network laboratories would trigger the bill’s reimbursement protections.
Headline styles
Require Lab Test Coverage
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3407
2017-2018 Regular Sessions
IN ASSEMBLY
January 27, 2017
Introduced by M. of A. DenDEKKER -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to health insurance coverage for clinical laboratory services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 34 to read as follows:
(34) No such policy shall limit or deny reimbursement for benefits to any insured on the basis that a laboratory providing clinical laboratory services is an out-of-network provider, if an in-network health care provider directs specimens retrieved by such health care provider to such out-of-network laboratory or such health care provider directs the insured to such out-of-network laboratory for clinical laboratory services. No such policy shall prohibit a duly registered laboratory from providing services, provided such laboratory agrees to provide such services in accordance with the minimum standards and conditions for similar providers that have been established by such policy.
§ 2. Subsection (e) of section 3221 of the insurance law is amended by adding a new paragraph 9 to read as follows:
(9) No such group or blanket policy shall limit or deny reimbursement for benefits to any insured on the basis that a laboratory providing clinical laboratory services is an out-of-network provider, if an in-network health care provider directs specimens retrieved by such health care provider to such out-of-network laboratory or such health care provider directs the insured to such out-of-network laboratory for clinical laboratory services. No such group or blanket policy shall prohibit a duly registered laboratory from providing services, provided such laboratory agrees to provide such services in accordance with the minimum standards and conditions for similar providers that have been established by such group or blanket policy.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08473-01-7
A. 3407 2
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (rr) to read as follows:
(rr) No such policy issued by a third party benefit program shall limit or deny reimbursement for benefits to any insured on the basis that a laboratory providing clinical laboratory services is an out-ofnetwork provider, if an in-network health care provider directs specimens retrieved by such health care provider to such out-of-network laboratory or such health care provider directs the insured to such out-of-network laboratory for clinical laboratory services. No such third party benefit program shall prohibit a duly registered laboratory from providing services, provided such laboratory agrees to provide such services in accordance with the minimum standards and conditions for similar providers that have been established by such third party benefit program.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such effective date.
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.