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Assembly Bill A3429

2009-2010 Legislative Session

Provides that claims for services by specialists may be subject to review by another specialist in the field if they are initially denied by the insurance company

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Archive: Last Bill Status - In Assembly Committee

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2009-A3429 (ACTIVE) - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Add ยง3240, Ins L

2009-A3429 (ACTIVE) - Summary

Provides that claims for services by specialists may be subject to review by another specialist in the field if they are initially denied by the insurance company; if the expert agrees that the services were medically necessary, then the insurance company must pay the requested claim.

2009-A3429 (ACTIVE) - Bill Text download pdf 

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

                                  3429

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 27, 2009
                               ___________

Introduced  by  M.  of A. BRADLEY, CYMBROWITZ, GALEF, FIELDS, BENEDETTO,
  ESPAILLAT, CLARK, PERRY, HOOPER -- Multi-Sponsored  by  --  M.  of  A.
  COLTON,  GREENE,  LATIMER, MAYERSOHN, PAULIN, PHEFFER, SCHIMEL -- read
  once and referred to the Committee on Insurance

AN ACT to amend the insurance law, in  relation  to  the  processing  of
  certain claims

  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  3240
to read as follows:
  S  3240. PROCESSING OF CLAIMS OF SERVICES RENDERED BY SPECIALISTS.  IF
A CLAIM FOR SERVICES  IS  DENIED  BY  AN  INSURANCE  COMPANY  AND  THOSE
SERVICES  WERE  PROVIDED FOR BY AN AMERICAN BOARD OF MEDICAL SPECIALTIES
(ABMS) CERTIFIED SPECIALIST, SUCH SPECIALIST MAY OPT TO HAVE THE  INSUR-
ANCE  COMPANY  HAVE THE CLAIM FOR SERVICES REVIEWED BY AN ABMS CERTIFIED
SPECIALIST IN THE SAME FIELD. IF  THE  REVIEWING  SPECIALIST  DETERMINES
THAT  THE RENDERED SERVICES WERE MEDICALLY NECESSARY, THEN THE INSURANCE
COMPANY SHALL GRANT THE CLAIM.
  S 2. This act shall take effect immediately.





 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03281-01-9

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