What's happening
This bill requires health insurers to let patients assign emergency benefits directly to out-of-network providers for payment.
Why it matters
Empowers patients by allowing them to direct insurance payments. Patients who get emergency care from out-of-network providers can now instruct their insurer to pay those providers directly, reducing the burden on patients to pay upfront and seek reimbursement.
Supports provider financial stability. Out-of-network emergency providers are more likely to receive timely payment, which can help reduce disputes and delays caused when insurers pay patients instead of sending funds directly to providers.
Minimizes patient financial risk and confusion. By ensuring payments go straight to providers, the bill aims to lower the risk of patients being sent to collections or facing double billing if they inadvertently cash insurance checks meant for providers.
Addresses administrative and billing inefficiencies. The change is likely to decrease paperwork and administrative hassles for both patients and providers, streamlining the claims process and potentially reducing errors in payment handling.
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Who cares
Headline styles
Let Patients Direct Emergency Payments
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
7107
2017-2018 Regular Sessions
IN ASSEMBLY
April 10, 2017
Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring health insurers to provide insureds and covered persons the option to assign the payment of emergency services benefits directly to an out of network health care provider
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (c) of section 3241 of the insurance law, as added by section 6 of part H of chapter 60 of the laws of 2014, is amended to read as follows:
(c) (1) When an insured or enrollee under a contract or policy that provides coverage for emergency services receives the services from a health care provider that does not participate in the provider network of an insurer, a corporation organized pursuant to article forty-three of this chapter, a municipal cooperative health benefit plan certified pursuant to article forty-seven of this chapter, a health maintenance organization certified pursuant to article forty-four of the public health law, or a student health plan established or maintained pursuant to section one thousand one hundred twenty-four of this chapter ("health care plan"), the health care plan shall ensure that the insured or enrollee shall (A) incur no greater out-of-pocket costs for the emergency services than the insured or enrollee would have incurred with a health care provider that participates in the health care plan's provider network and (B) provide the insured or enrollee the option of assigning the payment of any benefits due under such contract or policy directly to the health care provider. Whenever, in any health insurance claim form, an insured or enrollee specifically authorizes the payment of benefits directly to a health care provider, the health care plan shall make such payment to the health care provider. (2) For the purpose of this section, "emergency services" shall have the meaning set
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02605-01-7
A. 7107 2
forth in subparagraph (D) of paragraph nine of subsection (i) of section three thousand two hundred sixteen of this article, subparagraph (D) of paragraph four of subsection (k) of section three thousand two hundred twenty-one of this article, and subparagraph (D) of paragraph two of subsection (a) of section four thousand three hundred three of this chapter.
§ 2. This act shall take effect on the ninetieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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