senate Bill S1509

Directs health maintenance organization which denies claim due to absence of medical necessity to advise insured as to alternative treatment

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Sponsor

Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 02 / Feb / 2009
    • REFERRED TO INSURANCE
  • 06 / Jan / 2010
    • REFERRED TO INSURANCE

Summary

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Bill Details

Versions:
S1509
Legislative Cycle:
2009-2010
Current Committee:
Senate Insurance
Law Section:
Insurance Law

Sponsor Memo

BILL NUMBER: S1509

TITLE OF BILL :
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


PURPOSE :
This bill would amend the Insurance Law to require health maintenance
organizations to furnish an insured client, upon denial of coverage
for a requested treatment or procedure, the clinical standards used in
that determination.

SUMMARY OF PROVISIONS :
Section 1 -- Amends the Insurance Law by adding a new Section 2601-a
which directs health maintenance organizations to inform an insured
customer of the clinical standards used when denying a medical
procedure or treatment.

Section 2 -- Effective date.

JUSTIFICATION :
Insured individuals seeking care for a medical condition are sometimes
denied coverage for a particular procedure or treatment because it is
deemed medically necessary by an insurer. Currently, an insurer is
under no obligation to inform the insured about the standards used
when denying coverage for a medical treatment or procedure. This bill
would direct insurers to inform patients why the requested coverage
was denied.

LEGISLATIVE HISTORY :
S.4027 of 2007-2008
S.4497 of 2005-2006
S.853 of 2001-2002
S.6504 of 1999-2000

FISCAL IMPLICATIONS :
None.

EFFECTIVE DATE :
Thirty days after it shall have become a law.
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