S T A T E   O F   N E W   Y O R K
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                                  3171

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 23, 2009
                               ___________

Introduced  by  M.  of  A. BRADLEY, RABBITT, GALEF, FIELDS, ENGLEBRIGHT,
  LANCMAN -- Multi-Sponsored by -- M. of A. BOYLAND, GOTTFRIED,  MILLER,
  SWEENEY -- read once and referred to the Committee on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to  the assignment of reimbursement by an insured to an out-of-network
  provider

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subsection (g) of section 3217-b of the insurance law, as
relettered by chapter 586 of the laws of 1998, is relettered  subsection
(i) and a new subsection (g) is added to read as follows:
  (G)  NO  INSURER  SUBJECT  TO  THIS ARTICLE SHALL BY CONTRACT, WRITTEN
POLICY OR WRITTEN  PROCEDURE  PROHIBIT  OR  RESTRICT  ANY  INSURED  FROM
ASSIGNING  HIS  OR  HER  RIGHTS  TO REIMBURSEMENT FOR SERVICES UNDER THE
INSURANCE CONTRACT TO AN OUT-OF-NETWORK SERVICE PROVIDER. IF THE INSURER
IS SUPPLIED  WITH  SUCH  AN  ASSIGNMENT,  THE  INSURER  SHALL  MAKE  ANY
REIMBURSEMENT  PAYMENTS  DIRECTLY  TO THE OUT-OF-NETWORK PROVIDER.  UPON
MAKING PAYMENT TO THE OUT-OF-NETWORK PROVIDER, THE INSURER SHALL SEND AN
EXPLANATION OF THE  PAYMENT  TO  THE  INSURED.  SUCH  EXPLANATION  SHALL
INCLUDE  BUT  NOT  BE  LIMITED  TO,  THE  AMOUNT PAID TO THE HEALTH CARE
PROVIDER, THE PERCENTAGE OF THE TOTAL CLAIM REPRESENTED BY THE  PAYMENT,
THE  SERVICES  FOR  WHICH  PAYMENT  WAS  MADE,  THE HEALTH CARE PROVIDER
PROVIDING THOSE SERVICES AND THE CALCULATIONS FOR  PAYMENT,  BY  SERVICE
PROVIDED,  INCLUDING CO-PAYMENTS, DEDUCTIBLES, SURCHARGES AND FEE SCHED-
ULES.
  S 2. Subsection (g) of section 4325 of the insurance  law,  as  relet-
tered  by  chapter 586 of the laws of 1998, is relettered subsection (i)
and a new subsection (g) is added to read as follows:
  (G) NO INSURER SUBJECT TO THIS  ARTICLE  SHALL  BY  CONTRACT,  WRITTEN
POLICY  OR  WRITTEN  PROCEDURE  PROHIBIT  OR  RESTRICT  ANY INSURED FROM
ASSIGNING HIS OR HER RIGHTS TO  REIMBURSEMENT  FOR  SERVICES  UNDER  THE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03342-01-9
              

A. 3171                             2

INSURANCE CONTRACT TO AN OUT-OF-NETWORK SERVICE PROVIDER. IF THE INSURER
IS  SUPPLIED  WITH  SUCH  AN  ASSIGNMENT,  THE  INSURER  SHALL  MAKE ANY
REIMBURSEMENT PAYMENTS DIRECTLY TO THE OUT-OF-NETWORK  PROVIDER.    UPON
MAKING PAYMENT TO THE OUT-OF-NETWORK PROVIDER, THE INSURER SHALL SEND AN
EXPLANATION  OF  THE  PAYMENT  TO  THE  INSURED.  SUCH EXPLANATION SHALL
INCLUDE BUT NOT BE LIMITED TO,  THE  AMOUNT  PAID  TO  THE  HEALTH  CARE
PROVIDER,  THE PERCENTAGE OF THE TOTAL CLAIM REPRESENTED BY THE PAYMENT,
THE SERVICES FOR WHICH  PAYMENT  WAS  MADE,  THE  HEALTH  CARE  PROVIDER
PROVIDING  THOSE  SERVICES  AND THE CALCULATIONS FOR PAYMENT, BY SERVICE
PROVIDED, INCLUDING CO-PAYMENTS, DEDUCTIBLES, SURCHARGES AND FEE  SCHED-
ULES.
  S  3.  Subdivision  6  of  section  4406-c of the public health law is
renumbered subdivision 7 and a new subdivision 6 is  added  to  read  as
follows:
  6.  NO  INSURANCE  PLAN  SHALL  BY CONTRACT, WRITTEN POLICY OR WRITTEN
PROCEDURE PROHIBIT OR RESTRICT ANY INSURED FROM  ASSIGNING  HIS  OR  HER
RIGHTS  TO REIMBURSEMENT FOR SERVICES UNDER THE INSURANCE CONTRACT TO AN
OUT-OF-NETWORK SERVICE PROVIDER. IF THE INSURER IS SUPPLIED WITH SUCH AN
ASSIGNMENT, THE INSURER SHALL MAKE ANY REIMBURSEMENT  PAYMENTS  DIRECTLY
TO  THE  OUT-OF-NETWORK PROVIDER. UPON MAKING PAYMENT TO THE OUT-OF-NET-
WORK PROVIDER, THE INSURER SHALL SEND AN EXPLANATION OF THE  PAYMENT  TO
THE  INSURED. SUCH EXPLANATION SHALL INCLUDE, BUT NOT BE LIMITED TO, THE
AMOUNT PAID TO THE HEALTH CARE PROVIDER, THE  PERCENTAGE  OF  THE  TOTAL
CLAIM  REPRESENTED  BY  THE  PAYMENT, THE SERVICES FOR WHICH PAYMENT WAS
MADE, THE HEALTH CARE PROVIDER PROVIDING THOSE SERVICES AND  THE  CALCU-
LATIONS FOR PAYMENT, BY SERVICE PROVIDED, INCLUDING CO-PAYMENTS, DEDUCT-
IBLES, SURCHARGES AND FEE SCHEDULES.
  S  4.  This  act  shall take effect on the sixtieth day after it shall
have become a law and shall apply  to  any  insurance  contract  entered
into, amended or modified on or after such effective date.