BILL NUMBER:A10735
TITLE OF BILL: An act to amend the insurance law, in relation to
payments to prehospital emergency medical services providers
PURPOSE OR GENERAL IDEA OF BILL: To ensure that responding ambulance
service companies receive direct payment for all ambulance service
transports upon submission of an invoice to the insurance company with-
out the need for the responding ambulance company to be a preferred
provider.
SUMMARY OF PROVISIONS: Section 1 amends section 3224-a of the insurance
law to provide that payments made to nonparticipating or non-preferred
providers of ambulance services made by health insurers shall be done so
directly to the provider or jointly to both the provider and the
insured.
Section 2 amends subparagraphs (c) and (d) of paragraph 24 of subsection
(i) of section 3216 of the insurance law stating that the insurers shall
send such payments directly to the provider of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.
Section 3 amends subparagraphs (c) and (d) of.paragraph 15 of subsection
(1) of section 3221 of the insurance law stating that the insurers shall
S T A T E O F N E W Y O R K
________________________________________________________________________
10735
I N A S S E M B L Y
April 16, 2010
___________
Introduced by M. of A. MORELLE -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to payments to prehospi-
tal emergency medical services providers
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 3224-a of the insurance law is amended by adding a
new subsection (i) to read as follows:
(I) PAYMENTS TO NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU-
LANCE SERVICES LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC HEALTH LAW.
(1) WHENEVER AN INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
FIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW PROVIDES THAT ANY HEALTH CARE CLAIMS
SUBMITTED UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED INTO PURSUANT
TO THIS ARTICLE OR ARTICLES FORTY-TWO AND FORTY-THREE OF THIS CHAPTER
AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW ARE PAYABLE TO A PARTIC-
IPATING OR PREFERRED PROVIDER OF AMBULANCE SERVICES FOR SERVICES
RENDERED, THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
FIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO PAY SUCH BENE-
FITS EITHER DIRECTLY TO ANY SIMILARLY LICENSED NONPARTICIPATING OR
NONPREFERRED PROVIDER AT SAID PROVIDER'S USUAL AND CUSTOMARY CHARGE,
WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE, WHEN SAID PROVIDER HAS
RENDERED SUCH SERVICES, HAS A WRITTEN ASSIGNMENT OF BENEFITS, AND HAS
CAUSED WRITTEN NOTICE OF SUCH ASSIGNMENT TO BE GIVEN TO THE INSURER,
ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTICLE
FORTY-THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW OR JOINTLY TO SUCH NONPARTICIPATING OR NONPREFERRED PROVIDER AND TO
THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON; PROVIDED, HOWEVER,
THAT IN EITHER CASE THE INSURER, ORGANIZATION, OR CORPORATION LICENSED
OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENE-
FIT PAYMENTS DIRECTLY TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT.
WHEN PAYMENT IS MADE DIRECTLY TO A PROVIDER OF AMBULANCE SERVICES AS
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
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