What's happening
This bill requires health plans to directly reimburse out-of-network clinical laboratories 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 labs directly (rather than reimbursing the patient or not paying at all), the bill helps ensure patients aren't left responsible for large, unexpected lab bills when referred by their in-network doctor.
Protects provider-patient relationships. In-network providers can refer patients to the most appropriate lab—even if out-of-network—without concern that their patients will face complicated billing or delays in care due to insurance payment confusion.
Clarifies payment responsibility. The bill clearly assigns financial responsibility: enrollees still pay their usual copay, coinsurance, or deductible, but the health plan—not the patient—must pay the lab directly for covered services, reducing administrative hassle and potential financial risk for patients and labs.
Reduces administrative burden for clinical labs. Out-of-network labs can bill the insurer directly and are guaranteed payment within standard timeframes, improving cash flow and reducing the need for labs to chase payments from patients or insurance companies.
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
Require Lab Reimbursement by Insurers
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to health
- Referred to health
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 Out-of-Network Lab Providers
In Assembly Committee · Insurance · Sponsor David Weprin
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1323
2019-2020 Regular Sessions
IN SENATE
January 14, 2019
Introduced by Sen. FUNKE -- read twice and ordered printed, and when printed to be committed to the Committee on Health
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
S. 1323 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.
Sponsor's memo
Title of bill
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
Purpose of bill
To provide that organizations providing or offering comprehensive health service plans, such as managed care organizations and health maintenance organizations, directly reimburse out-of-network providers of clinical laboratory services when plan participants are referred to out-of-net- work providers by in-network organizations or providers.
Summary of specific provisions
Section 1. Section 4406 of the public health law by adding a new subdi- vision 6. The new subdivision provides when the participant or enrollee is referred to non-participating medical providers by in-network medical providers, the services must be reimbursable under the plan; requiring the out-of-network to bill the in-network organization directly for services performed. Any payment made by the medical provider directly to the participant rather than to the out-of-network provider will not satisfy the organization's payment obligation to the clinical laborato- ry.
Section 4804 of the insurance law is amended by adding a new subsection (g) to with provisions that are identical to the foregoing.
Justification
In an effort to provide the best health care available, health care organizations and providers regularly refer patients to providers outside of such patients' organization's networks. Under current law, however, such organizations are not required to directly reimburse out- of-network providers for clinical laboratory services rendered. Instead, out-of-network providers of clinical laboratory services must look directly to the patients for payment of their fees, even though patients are less likely to pay for the services once rendered and may assume that the organization is required to pay for the services. This discourages out-of-network providers to render services to such patients even in cases where the out of network provider may offer better services. This practice also conflicts with medical advice and recommen- dation of the patient's medical care giver and limits patient healthcare options.
This legislation would expand the health care service options available to the residents of the state and promote the referral of patients to providers deemed to be the best for the medical care of such patients, whether in or out-of-network
Prior legislative history
S.5374/A.3527 of 2015-2016; Referred to Health S.1083/A.636 of 2013-2014; Referred to Health S.2817/A.3802 of 2011-2012; Committee Discharged and Committed to Rules
Fiscal implications for state and local governments
None.
Effective date
This act shall take effect immediately
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.