What's happening
This bill requires insurers to pay ambulance service providers directly, including nonparticipating ones, at negotiated or customary rates if benefits are assigned.
Why it matters
Ensures ambulance providers (including those outside insurer networks) are paid directly. when patients assign insurance benefits to them, reducing delays and administrative burdens for both patients and providers.
Requires insurers to reimburse at negotiated or “usual and customary” rates. if no agreement exists, potentially improving financial stability for emergency medical service providers and discouraging underpayment.
May help patients avoid “surprise billing” issues. by streamlining payments directly to ambulance services, lessening the risk that patients are left to pay the provider out of pocket and then seek reimbursement.
Clarifies applicability and limitations. The bill specifically excludes non-covered ambulance services and inter-facility transfers unless the policy explicitly covers them, so its protections are focused on emergency and covered situations.
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Who cares
Headline styles
Pay All Ambulance Providers
Plain English, a few words. Used as the page title.
Sponsors
History
- Print number 2527a
- Amend and recommit to insurance
- 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.
Pay All Ambulance Providers
In Assembly Committee · Insurance · Sponsor William Magnarelli
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2527--A
2017-2018 Regular Sessions
IN SENATE
January 13, 2017
Introduced by Sens. SEWARD, ADDABBO, AKSHAR, AVELLA, BOYLE, BRESLIN, FUNKE, GALLIVAN, MARCHIONE -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to payments to prehospital emergency medical services providers
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3224-a of the insurance law is amended by adding a new subsection (k) to read as follows:
(k) Payments to nonparticipating or nonpreferred providers of ambulance services licensed under article thirty of the public health law. (1) Whenever an insurer or an organization, or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law provides that any health care claims submitted under contracts or agreements issued or entered into pursuant to this article or article forty-two, forty-three or forty-seven of this chapter and article forty-four of the public health law are payable to a participating or preferred provider of ambulance services for services rendered, the insurer, organization, or corporation licensed or certified pursuant to article forty-three or fortyseven of this chapter or article forty-four of the public health law shall be required to pay such benefits either directly to any similarly licensed nonparticipating or nonpreferred provider at the usual and customary charge, which shall not be excessive or unreasonable, when the provider has rendered such services, has on file a duly executed assignment of benefits, and has caused notice of such assignment to be given to the insurer, organization, or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or arti-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00551-04-8
S. 2527--A 2
cle forty-four of the public health law or jointly to such nonparticipating or nonpreferred provider and to the insured, subscriber, or other covered person; provided, however, that in either case the insurer, organization, or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law shall be required to send such benefit payments directly to the provider who has the assignment on file. When payment is made directly to a provider of ambulance services as authorized by this section, the insurer, organization, or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law shall give written notice of such payment to the insured, subscriber, or other covered person.
(2) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable.
(3) Nothing contained in this section shall be deemed to prohibit the payment of different levels of benefits or from having differences in coinsurance percentages applicable to benefit levels for services provided by participating or preferred providers and nonparticipating or nonpreferred providers.
The provisions of this section shall not apply to policies that do not include coverage for ambulance services.
§ 2. Subparagraphs (C) and (D) of paragraph 24 of subsection (i) of section 3216 of the insurance law, as added by chapter 506 of the laws of 2001, are amended to read as follows:
(C) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable. The insurer shall send such payments directly to the provider of such ambulance services, if the ambulance service has on file an executed assignment of benefits form with the claim.
(D) The provisions of this paragraph shall have no application to transfers of patients between hospitals or health care facilities by an ambulance service as described in subparagraph (A) of this paragraph unless such services are covered under the policy.
§ 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of section 3221 of the insurance law, as added by chapter 506 of the laws of 2001, are amended to read as follows:
(C) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable. The insurer shall send such payments directly to the provider of such ambulance services, if the ambulance service has on file an executed assignment of benefits form with the claim.
(D) The provisions of this paragraph shall have no application to transfers of patients between hospitals or health care facilities by an ambulance service as described in subparagraph (A) of this paragraph unless such services are covered under the policy.
S. 2527--A 3
§ 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the insurance law, as added by chapter 506 of the laws of 2001, are amended to read as follows:
(3) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable. The insurer shall send such payments directly to the provider of such ambulance services, if the ambulance service has on file an executed assignment of benefits form with the claim.
(4) The provisions of this subsection shall have no application to transfers of patients between hospitals or health care facilities by an ambulance service as described in paragraph one of this subsection unless such services are covered under the policy.
§ 5. This act shall take effect January 1, 2020 and shall apply to health care claims submitted for payment after such date.
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 payments to prehospital emergency medical services providers
Purpose
To ensure that responding ambulance service companies receive direct payment for all ambulance service transports upon submission of an invoice to the insurance company without the need for the responding ambulance company to be a preferred provider.
Summary of provisions
Section 1 amends section 3224-a of the insurance law to provide that payments made to nonparticipating or non-preferred providers of ambu- lance services made by health insurers shall be done so directly to the provider or jointly to both the provider and the insured.
Read the full memo (657 words)
Section 2 amends subparagraphs (c) and (d) of paragraph 24 of subsection (i) of section 3216 of the insurance law stating that the insurers shall send such payments directly to the provider of such ambulance services if the ambulance service includes an executed assignment of benefits form with the claim and the provisions of this paragraph shall apply to transfers of patients between hospitals or health care facilities.
Section 3 amends subparagraphs (c) and (d) of paragraph 15 of subsection (1) of section 3221 of the insurance law stating that the insurers shall send such payments directly to the provider of such ambulance services if the ambulance service includes an executed assignment of benefits form with the claim and the provisions of this paragraph shall apply to transfers of patients between hospitals or health care facilities.
Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303 of the insurance law stating that the insurers shall send such payments directly to the provider of such ambulance services if the ambulance service includes an executed assignment of benefits form with the claim and the provisions of this paragraph shall apply to transfers of patients between hospitals or health care facilities.
Section 5. Effective Date.
Justification
The constant and quick availability of ambulance response is something that all of our citizens have grown accustomed to and it is essential to the survivability of all New Yorkers when there is a medical crisis. Fair and direct reimbursement for those services is paramount to the financial stability and continued availability of ambulances to respond.
Current law permits insurance companies to pay for ambulance service charges direct to the patient until and unless the ambulance company becomes a preferred provider of that specific insurance company. It is not practical to expect a preferred provider relationship with every insurance company. But then it is the responsibility of the ambulance company to try to recoup payment for service from that patient.
All types of EMS providers routinely are not paid by the patient for ambulance services even though the patient receives payment from the insurance company. Especially as the financial crisis we are currently facing deepens, more and more patients are pocketing these funds. Further, the insurance company is not obligated to advise the ambulance company that they in fact paid the ambulance transport bill direct to the patient. This disconnect of information leads to confusion and furthers the lack of proper payment issue.
In New York State, ambulance companies are mandated responders. As such, most ambulance providers have no knowledge of the patient's ability to pay or if or by whom they are insured by when a medical emergency or accidental event occurs. Ambulance service is one of the few medical services where payment is not expected at the time of service.
This legislation will assure that responding ambulance service will receive direct payment for all ambulance service transports upon submission of an invoice to the insurance company without the need for the responding ambulance company to be a preferred provider.
Legislative history
S.1764 of 2015-16; S.3542 of 2013-14; S.2714-8 of 2011-12; S.4462 of 2010.
Fiscal implications
None.
Effective date
This act shall take effect January 1, 2020 and shall apply to health care claims submitted for payment after such date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.