Assembly Actions - Lowercase Senate Actions - UPPERCASE |
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Jun 17, 2010 | reference changed to insurance |
Jun 11, 2010 | reference changed to health |
Jun 08, 2010 | referred to insurance |
Archive: Last Bill Status - In Assembly Committee
- Introduced
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- Passed Assembly
- Delivered to Governor
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A11385 (ACTIVE) - Details
A11385 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 11385 I N A S S E M B L Y June 8, 2010 ___________ Introduced by M. of A. D. WEPRIN -- 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 laborato- ry services by organizations providing or offering comprehensive health services plans THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, 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. S 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 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 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.