What's happening
This bill requires patients be notified if an out-of-network physician may be used, and covers costs if notification is not given.
Why it matters
Empowers patients to make informed choices. by ensuring they are told in advance if an out-of-network physician could be involved in their care, helping them avoid unexpected medical bills.
Shifts financial risk from patients to insurers. when notification isn’t provided—if proper notice isn’t given, insurance must cover costs that would have fallen on the patient, reducing surprise billing and financial stress.
Creates new accountability for billing entities and providers. , incentivizing them to communicate clearly and promptly with patients about network status to avoid liability for out-of-network charges.
May impact insurance premiums or provider practices. over time, as insurers could adjust policies or negotiate differently with providers to manage the new financial risk created by the notification requirement.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Insured patients
They would be entitled to advance notice that an out-of-network physician may participate in their procedure, test or surgery and that the physician’s services would not be covered by their policy.
Accident and health insurers
They would have to cover patient costs for out-of-network physician services if the insured person did not receive the required advance notice.
Health care billing entities
They would be responsible for notifying insured patients before the procedure, test or surgery about the possible use of an out-of-network physician and lack of coverage.
Headline styles
Notify Patients of Out-of-Network Doctors
Plain English, a few words. Used as the page title.
Sponsors
1 Multi-sponsor
History
- Referred to insurance
- Referred to insurance
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7332
2017-2018 Regular Sessions
IN ASSEMBLY
April 24, 2017
Introduced by M. of A. TITONE, STECK, MONTESANO, HOOPER, PERRY, ABINANTI -- Multi-Sponsored by -- M. of A. McDONOUGH, SIMANOWITZ -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring notification to insured persons that an out-of-network physician may be used in their procedure, test or surgery
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3216 of the insurance law is amended by adding a new subsection (n) to read as follows:
(n) (1) Every person insured under a policy of accident and health insurance delivered or issued for delivery in this state shall be entitled to notification from the billing entity prior to the procedure, test or surgery, that an out-of-network physician may be used in such procedure, test or surgery and such physician's services shall not be covered by their insurance policy.
(2) The patient costs of out-of-network physician services shall be covered by the insurance policy of an insured person if he or she has not received notification of such situations, prior to the health service or procedure, as prescribed in paragraph one of this subsection.
§ 2. Section 3221 of the insurance law is amended by adding a new subsection (t) to read as follows:
(t) (1) Every person insured under a policy of accident and health insurance delivered or issued for delivery in this state shall be entitled to notification from the billing entity prior to the procedure, test or surgery, that an out-of-network physician may be used in such procedure, test or surgery and such physician's services shall not be covered by their insurance policy.
(2) The patient costs of out-of-network physician services shall be covered by the insurance policy of an insured person if he or she has not received notification of such situations, prior to the health service or procedure, as prescribed in paragraph one of this subsection.
§ 3. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11010-01-7
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.