What's happening
This bill requires insurance companies to pay ambulance service claims directly to providers or through joint checks, with specific notification requirements.
Why it matters
Reduces payment delays for ambulance providers. by ensuring that insurance companies pay them directly or through a joint check, which can help maintain critical ambulance operations and prevent financial strain from slow or misdirected reimbursements.
Protects patients from becoming intermediaries. in the payment process; with direct payments or joint checks, patients are less likely to be caught between insurers and providers or to face pressure to forward payments themselves.
Improves transparency and accountability. by requiring insurers to notify ambulance providers electronically when payments are issued, including details such as patient name, service and payment dates, payment amount, and mailing address, which can help providers track and reconcile payments more easily.
Clarifies assignment of benefits rules. so that if a patient assigns insurance benefits to the ambulance provider, insurers must honor that assignment regardless of other policy language, further streamlining payment and supporting provider financial stability.
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Who cares
Headline styles
Direct Payments for Ambulance Services
Plain English, a few words. Used as the page title.
Sponsors
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Direct Ambulance Payment Reform
In Assembly Committee · Insurance · Sponsor J. Gary Pretlow
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2524
2017-2018 Regular Sessions
IN SENATE
January 13, 2017
Introduced by Sens. SEWARD, ADDABBO, AVELLA, FUNKE, GALLIVAN -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to reimbursement for ambulance services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. 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 at the rates negotiated between the provider and the insurer, or if no rate has been negotiated between the provider and insurer, then to the insured in the form of a joint check specifying as payees both the insured and the provider of ambulance services, at the usual and customary charge, which shall not be excessive or unreasonable; provided however, if the provider of ambulance services has on file a duly executed assignment of benefits for such services to the insurer, notwithstanding any policy language to the contrary, the issuer shall accept such assignment of benefits and the insurer shall issue reimbursement solely to the provider. An insurer issuing payment in the form of a joint check shall notify the provider via electronic communication of the issuance of such payment. The notification shall include the name of the patient, the date of service, the date of payment, the amount of payment and the address to which the payment was sent.
§ 2. Paragraph 15 of subsection (1) 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 at the rates negotiated between the provider and the insurer, or if no rate has been
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04476-01-7
S. 2524 2
negotiated between the provider and insurer, then to the insured in the form of a joint check specifying as payees both the insured and the provider of ambulance services, at the usual and customary charge, which shall not be excessive or unreasonable; provided however, if the provider of ambulance services has on file a duly executed assignment of benefits for such services to the insurer, notwithstanding any policy language to the contrary, the insurer shall accept such assignment of benefits and the insurer shall issue reimbursement solely to the provider. An insurer issuing payment in the form of a joint check shall notify the provider via electronic communication of the issuance of such payment. The notification shall include the name of the patient, the date of service, the date of payment, the amount of payment and the address to which the payment was sent.
§ 3. Subsection (aa) of section 4303 of the insurance law is amended by adding a new paragraph 6 to read as follows:
(6) An insurer who issues reimbursement under this subsection shall submit such payments either directly to the provider at the rates negotiated between the provider and the insurer, or if no rate has been negotiated between the provider and insurer, then to the insured in the form of a joint check specifying as payees both the insured and the provider of ambulance services, at the usual and customary charge, which shall not be excessive or unreasonable; provided however, if the provider of ambulance services has on file a duly executed assignment of benefits for such services to the insurer, notwithstanding any policy language to the contrary, the insurer shall accept such assignment of benefits and the insurer shall issue reimbursement solely to the provider. An insurer issuing payment in the form of a joint check shall notify the provider via electronic communication of the issuance of such payment. The notification shall include the name of the patient, the date of service, the date of payment, the amount of payment and the address to which the payment was sent.
§ 4. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to reimbursement for ambulance services
Purpose
To require insurers to submit payments directly to ambulance providers who are in-network or, for out-of-network ambulance providers, to require the issuance of a joint check to the insured specifying both the insured and the ambulance provider as payees.
Summary of provisions
Amends sections 3216(i)(24), 3221(1)(15) and 4303(aa) to require insurers to submit payments directly to in-network ambulance providers at the negotiated rates. For out-of-network ambulance providers where there is no negotiated rate, the insurer is required to issue a joint check to the insured specifying both the insured and ambulance provider as payees, at the usual and customary charge.
Further, the legislation requires the insurer to issue reimbursement directly to the ambulance provider if the insured has filed an assignment of benefits for such ambulance services.
The legislation also requires the insurer to notify the ambulance provider electronically upon the issuance of a joint check to the insured. The notification must include the name of the patient, date of service, date of payment, amount of payment and address to which the payment was sent.
Justification
This bill would amend the insurance law to require insurers to issue joint signature checks to both the patient and ambulance service provider when the patient utilizes an ambulance service provider that is a non-participating provider of their network.
Currently, when a patient uses an out-of-network ambulance provider, their insurance company will send the ambulance reimbursement payment directly to the patient. The patient is then expected to forward that reimbursement payment to the ambulance service that provided the service. In many cases with a single signature check, the patients never send the insurance reimbursement to the service provider. Rather, they keep the money for themselves, diverting millions of dollars from our healthcare system in the process.
This bill would ensure that healthcare dollars stay in the healthcare system and that healthcare providers are paid for the work that they do. In order to cash the check, both parties would need to endorse the check. Insurers would send the joint signature check to the patient, the patient would sign it and send it to the ambulance provider. The ambulance provider could then endorse the check and be paid for their service. The insurer will also notify the ambulance provider when a joint signature check has been sent to the patient.
Ambulance providers are mandated responders who must provide service when an emergency call comes in. They answer these calls without knowledge of a patient's ability to pay and without concern of being paid at the time of service. In order to keep the ambulance system strong and viable they must collect payment for service. This bill would assist in collecting payments.
Legislative history
S.1763 of 2015-16; S.3541 of 2013-14; S.6982 of 2012
Fiscal implications
None.
Effective date
Immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.