senate Bill S1509

2009-2010 Legislative Session

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

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Archive: Last Bill Status - In Committee


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 06, 2010 referred to insurance
Feb 02, 2009 referred to insurance

S1509 - Bill Details

Current Committee:
Law Section:
Insurance Law

S1509 - Bill Texts

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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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