What's happening
The bill requires health plans to pay out-of-network clinical laboratories directly when enrollees are referred by in-network providers.
Why it matters
Prevents patients from being caught in billing disputes. By requiring health plans to pay out-of-network laboratories directly (when referred by in-network providers), the bill shields patients from having to act as intermediaries or face collection actions for lab bills.
Reduces administrative burden for labs and providers. Out-of-network laboratories can bill health plans directly rather than chasing payment from patients or waiting for insurers to reimburse patients, streamlining the payment process.
Limits patient financial responsibility to plan terms. Patients are only responsible for their usual copays, coinsurance, or deductibles, not the full out-of-network lab costs, as long as the referral came from an in-network provider.
Closes loopholes that could delay payment. The law prohibits insurance organizations from fulfilling their payment obligations by sending payments to enrollees instead of directly to the laboratories, ensuring labs receive timely and proper compensation.
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Who cares
Headline styles
Pay Out-of-Network Lab Providers
Plain English, a few words. Used as the page title.
Sponsors
1 Multi-sponsor
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.
Require Lab Reimbursement by Insurers
In Senate Committee · Health · Sponsor Rich Funke
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3928
2019-2020 Regular Sessions
IN ASSEMBLY
January 31, 2019
Introduced by M. of A. WEPRIN -- Multi-Sponsored by -- M. of A. JAFFEE -- read once and referred to the Committee on Insurance
AN ACT to amend the public health law and the insurance law, in relation to the reimbursement of out-of-network providers of clinical laboratory services by organizations providing or offering comprehensive health services plans
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 4406 of the public health law is amended by adding a new subdivision 6 to read as follows:
6. Notwithstanding any other provision of law, if an enrollee is referred by an in-plan provider to a provider of clinical laboratory services not participating in the plan (a "non-participating provider") for any service covered under the terms of the plan, the organization shall be responsible for payment directly to the non-participating provider for those services in accordance with the time frame for such payments set forth in section three thousand two hundred twenty-four-a of the insurance law; provided, however, that the enrollee shall be responsible for any applicable copay, coinsurance or deductible for such services. Clinical laboratories seeking reimbursement pursuant to this section for services rendered shall directly bill the organization whose enrollee received the services. Any payment made by an organization directly to the enrollee rather than to the clinical laboratory seeking reimbursement shall not satisfy the organization's payment obligation to the clinical laboratory.
§ 2. Section 4804 of the insurance law is amended by adding a new subsection (g) to read as follows:
(g) Notwithstanding any other provision of law, if an enrollee is referred by an in-plan provider to a provider of clinical laboratory services not participating in the plan (a "non-participating provider") for any service covered under the terms of the plan, the organization
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07070-01-9
A. 3928 2
shall be responsible for payment directly to the non-participating provider for those services in accordance with the time frame for such payments set forth in section three thousand two hundred twenty-four-a of this chapter; provided, however, that the enrollee shall be responsible for any applicable copay, coinsurance or deductible for such services. Clinical laboratories seeking reimbursement pursuant to this section for services rendered shall directly bill the organization whose enrollee received the services. Any payment made by an organization directly to the enrollee rather than to the clinical laboratory seeking reimbursement shall not satisfy the organization's payment obligation to the clinical laboratory.
§ 3. This act shall take effect immediately.
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.