What's happening
This bill restricts insurance companies from denying payment for medically necessary additional procedures performed during authorized treatments, except under specific conditions.
Why it matters
Reduces surprise medical billing risk for patients. By limiting insurance denials for necessary additional procedures during authorized treatments, patients are less likely to face unexpected out-of-pocket costs for care they had little control over.
Empowers healthcare providers’ clinical judgment. The bill recognizes providers' on-the-spot medical decisions, ensuring they can address urgent or related health issues without administrative delays or risking non-payment.
Clarifies insurance exceptions for denial. Insurers can still deny payment only under specific conditions (e.g., service not covered, not medically necessary, experimental/investigational, or other strict statutory criteria), improving transparency about when denials are legitimate.
Covers billing code discrepancies. Payment protections apply even if the additional procedure uses a different billing (CPT) code than the original authorized service, closing a common loophole used to deny coverage.
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
Headline styles
Protect Emergency Medical Coverage
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Substituted by S5328A
- Amended on third reading 2880b
- Amended on third reading (t) 2880a
- Vote reconsidered - restored to third reading
- Returned to assembly
- Recalled from senate
- Referred to rules
- Delivered to senate
- Passed assembly
- Advanced to third reading cal.493
- Reported
- Reported referred to codes
Show 1 earlier action
- 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.
Protect Patients' Coverage Rights
Signed by Governor · Sponsor Neil D. Breslin
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2880--B Cal. No. 493
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
Introduced by M. of A. HUNTER -- read once and referred to the Committee on Insurance -- reported and referred to the Committee on Codes -advanced to a third reading, passed by Assembly and delivered to the Senate, recalled from the Senate, vote reconsidered, bill amended, ordered reprinted, retaining its place on the order of third reading -- again amended on third reading, ordered reprinted, retaining its place on the order of third reading
AN ACT to amend the insurance law, in relation to denial of coverage of additional or related services or procedures related to health care services for which pre-authorization was granted or did not require pre-authorization; and to repeal certain provisions of such law relating thereto
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (c) of section 3238 of the insurance law is REPEALED and a new subsection (c) is added to read as follows:
(c)(1) If a health care provider, while providing a service or procedure to treat a patient, determines that providing an additional or related service or procedure, such as a service or procedure to address a co-morbid condition, is immediately necessary as part of such treatment, and in the clinical judgment of the health care provider it is a medically timely service and it would not be medically advisable to interrupt the provision of care to the patient in order to obtain preauthorization from a health plan for the additional or related service or procedure, a denial of payment for the additional or related service or procedure due to lack of pre-authorization shall be upheld on appeal only if it is determined that:
(i) the additional or related service or procedure is not a covered benefit;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04761-07-9
A. 2880--B 2
(ii) the additional or related service or procedure was not medically necessary pursuant to section four thousand nine hundred four of this chapter or section forty-nine hundred four of the public health law;
(iii) the additional or related service or procedure was experimental or investigational pursuant to section four thousand nine hundred four of this chapter or section forty-nine hundred four of the public health law; or
(iv) one of the conditions set forth in paragraphs one through six of subsection (a) of this section is met.
(2) The provisions of this subsection shall apply to situations in which pre-authorization was required and received for the initial service or procedure.
(3) The provisions of this subsection shall apply without regard to whether the current procedural terminology (CPT) code for the additional or related service or procedure is different than the CPT code for the initial service or procedure.
§ 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.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.