What's happening
This bill requires health insurance policies to cover out-of-network clinical laboratory services if referred by an in-network provider.
Why it matters
Reduces surprise medical bills for patients. By requiring insurance coverage for out-of-network lab services ordered by in-network providers, the bill helps protect patients from unexpected, often costly, charges they might otherwise face.
Supports continuity of care and physician decision-making. In-network providers sometimes need to use specific out-of-network labs for specialized tests or faster results. This bill ensures those clinical decisions aren’t limited by insurance network restrictions, which could benefit patient outcomes.
Promotes fair access to laboratory services. The bill allows any duly registered laboratory to provide services as long as they agree to meet the insurer’s minimum standards, potentially increasing patient access to a wider range of labs and services.
May impact insurance premiums and provider negotiations. By mandating broader coverage, insurers could face higher costs, which might influence future premium rates or change how insurers negotiate contracts with clinical labs.
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Who cares
Headline styles
Protect Out-of-Network Lab Coverage
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3901
2019-2020 Regular Sessions
IN ASSEMBLY
January 31, 2019
Introduced by M. of A. DenDEKKER -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to health insurance coverage for clinical laboratory services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 35 to read as follows:
(35) No such policy shall limit or deny reimbursement for benefits to any insured on the basis that a laboratory providing clinical laboratory services is an out-of-network provider, if an in-network health care provider directs specimens retrieved by such health care provider to such out-of-network laboratory or such health care provider directs the insured to such out-of-network laboratory for clinical laboratory services. No such policy shall prohibit a duly registered laboratory from providing services, provided such laboratory agrees to provide such services in accordance with the minimum standards and conditions for similar providers that have been established by such policy.
§ 2. Subsection (e) of section 3221 of the insurance law is amended by adding a new paragraph 9 to read as follows:
(9) No such group or blanket policy shall limit or deny reimbursement for benefits to any insured on the basis that a laboratory providing clinical laboratory services is an out-of-network provider, if an in-network health care provider directs specimens retrieved by such health care provider to such out-of-network laboratory or such health care provider directs the insured to such out-of-network laboratory for clinical laboratory services. No such group or blanket policy shall prohibit a duly registered laboratory from providing services, provided such laboratory agrees to provide such services in accordance with the minimum standards and conditions for similar providers that have been established by such group or blanket policy.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07981-01-9
A. 3901 2
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
(ss) No such policy issued by a third party benefit program shall limit or deny reimbursement for benefits to any insured on the basis that a laboratory providing clinical laboratory services is an out-ofnetwork provider, if an in-network health care provider directs specimens retrieved by such health care provider to such out-of-network laboratory or such health care provider directs the insured to such out-of-network laboratory for clinical laboratory services. No such third party benefit program shall prohibit a duly registered laboratory from providing services, provided such laboratory agrees to provide such services in accordance with the minimum standards and conditions for similar providers that have been established by such third party benefit program.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such effective date.
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.