S T A T E O F N E W Y O R K
________________________________________________________________________
2571
2009-2010 Regular Sessions
I N A S S E M B L Y
January 20, 2009
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Introduced by M. of A. PRETLOW, PHEFFER -- Multi-Sponsored by -- M. of
A. AUBRY, CAHILL, CANESTRARI, CLARK, COLTON, COOK, CUSICK, CYMBROWITZ,
EDDINGTON, ENGLEBRIGHT, ESPAILLAT, FARRELL, GLICK, GREENE, HIKIND,
MAYERSOHN, McENENY, MILLMAN, NOLAN, ORTIZ, SCARBOROUGH -- read once
and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to notice by health main-
tenance organizations that a request for coverage of a particular
treatment is denied
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The insurance law is amended by adding a new section 2601-a
to read as follows:
S 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 NECES-
SARY, 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.
S 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.
LBD02128-02-9