What's happening
Requires health maintenance organizations to inform patients of covered alternatives or past ineffectiveness when denying treatment coverage.
Why it matters
Enhances transparency and patient understanding. by requiring health maintenance organizations (HMOs) to explain why a requested treatment was denied, including whether it's been ineffective in the past or what covered alternatives exist.
Empowers patients to make informed decisions. about their care by providing them with clear information on what treatments are preferred or covered, which may help them advocate more effectively for their health needs.
Could reduce frustration and appeals. by clarifying coverage criteria upfront, potentially streamlining the process for patients and providers when dealing with denied claims.
May lead to greater accountability for HMOs. as they must justify denials with specific information, which could help patients and regulators monitor patterns of denials and ensure fair treatment.
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
Health maintenance organizations
HMOs doing business in New York would have to tell insured patients whose claims are denied as medically unnecessary about covered preferred treatment options or provide a statement about the requested treatment’s past ineffectiveness.
HMO enrollees
Patients denied coverage on medical-necessity grounds would receive information on covered alternatives or the past ineffectiveness of their requested procedure or treatment.
Doctors and other treating providers
The required information could help them discuss covered treatment alternatives or the HMO’s explanation of past ineffectiveness with patients.
Headline styles
Insurers Must Suggest Alternatives
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
4103
2019-2020 Regular Sessions
IN ASSEMBLY
February 1, 2019
Introduced by M. of A. PRETLOW -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to notice by health maintenance organizations that a request for coverage of a particular treatment is denied
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. The insurance law is amended by adding a new section 2601-a to read as follows:
§ 2601-a. Denial of coverage or treatment by a health maintenance organization. Whenever a health maintenance organization, doing business in this state, denies a claim for coverage of a particular procedure or treatment because such procedure or treatment is not medically necessary, the health maintenance organization shall inform the insured as to those preferred procedure or treatment options which would be covered, or provide the insured with a statement as to the past ineffectiveness of the requested procedure or treatment.
§ 2. This act shall take effect on the thirtieth day after it shall have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04342-01-9
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.