What's happening
This bill requires health insurance policies to provide equal coverage and reimbursement for podiatric care as for similar medical services.
Why it matters
Ensures podiatric care is not treated less favorably by insurers. The bill requires that deductibles, copays, benefit limits, and utilization reviews for podiatric care must be no more restrictive than for similar services provided by other health professionals, preventing insurance plans from singling out podiatry for worse coverage.
Reduces discriminatory barriers to foot and ankle health. By mandating parity in coverage, the legislation seeks to eliminate insurance policies that discourage or limit access to podiatric care, which can be essential for people with diabetes, mobility issues, or chronic foot conditions.
Expands patient choice and provider access. Patients can choose a licensed podiatrist for foot and ankle care without worrying about higher costs or limited benefits, supporting timely and specialized treatment for relevant conditions.
Clarifies hospital privileges and employment for podiatrists. The bill affirms that insurance coverage cannot be used to block podiatric care provided by licensed podiatrists in hospital settings, helping ensure podiatrists are recognized as part of the healthcare team in these facilities.
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Who cares
Headline styles
Expand Podiatry Insurance Coverage
Plain English, a few words. Used as the page title.
Sponsors
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
4937
2017-2018 Regular Sessions
IN ASSEMBLY
February 6, 2017
Introduced by M. of A. WEPRIN -- Multi-Sponsored by -- M. of A. COLTON, GALEF, GUNTHER, HOOPER, PERRY, TITONE -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage and benefits of accident and health insurance policies for podiatric care
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 2 of subsection (i) of section 3216 of the insurance law is amended to read as follows:
(2) If a policy provides for reimbursement for any podiatrical service within the lawful scope of practice of a licensed podiatrist, the insured shall be entitled to the same reimbursement for such service whether it is performed by a physician or licensed podiatrist.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 22 to read as follows:
(22) Every policy which provides coverage for podiatric care, as defined in section seven thousand one of the education law, provided by a doctor of podiatry licensed pursuant to article one hundred forty-one of the education law, may be subject to reasonable deductible, co-payment and co-insurance amounts, reasonable fee or benefit limits and reasonable utilization review, provided that any such amounts, limits and review: (A) shall not function to direct treatment in a manner discriminative against podiatric care; and (B) individually and collectively shall be no different than those applicable under that same policy to care or services provided by other health professionals in the diagnosis, treatment and management of the same or similar conditions, disorders or injuries. Nothing in this paragraph shall be construed as impeding or preventing either the provision or coverage of podiatric care and services by duly licensed doctors of podiatry within the lawful scope of podiatric care in hospital facilities on a staff or employee basis.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09373-01-7
A. 4937 2
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (rr) to read as follows:
(rr) Every contract issued by a health service corporation or a medical expense indemnity corporation that includes coverage for physician services in a physician's office, that provides major medical or similar comprehensive-type coverage, and coverage for podiatric care as defined in section seven thousand one of the education law, provided by a doctor of podiatry licensed pursuant to article one hundred forty-one of the education law, may be subject to reasonable deductible, co-payment and co-insurance amounts, reasonable fee or benefit limits and reasonable utilization review, provided that any such amounts, limits and review: (1) shall not function to direct treatment in a manner discriminative against podiatric care; and (2) individually and collectively shall be no different than those applicable under the same policy to care or services provided by other health professionals in the diagnosis, treatment and management of the same or similar conditions, disorders or injuries. Nothing in this subsection shall be construed as impeding or preventing either the provisions or coverage of podiatric care and services by duly licensed doctors of podiatry within the lawful scope of podiatric care in hospital facilities on a staff or employee basis.
§ 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 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.
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