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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 Senate Committee Insurance Committee

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2009-S1509 (ACTIVE) - Details

Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add ยง2601-a, Ins L

2009-S1509 (ACTIVE) - Summary

Directs health maintenance organization which denies claim due to absence of medical necessity to inform insured as to the clinical standards used for the health maintenance organization's determination.

2009-S1509 (ACTIVE) - Sponsor Memo

2009-S1509 (ACTIVE) - Bill Text download pdf 

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

                                  1509

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                            February 2, 2009
                               ___________

Introduced by Sens. DeFRANCISCO, GRIFFO, LARKIN, LAVALLE, MORAHAN, VOLK-
  ER -- read twice and ordered printed, and when printed to be committed
  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 MEMBER AS  TO
THE  CLINICAL  STANDARDS  USED FOR THE HEALTH MAINTENANCE ORGANIZATION'S
DETERMINATION. FOR THE PURPOSES OF THIS  SECTION,  "CLINICAL  STANDARDS"
SHALL  HAVE  THE  MEANING  ASCRIBED  BY SUBSECTION (B-1) OF SECTION FOUR
THOUSAND NINE HUNDRED OF THIS CHAPTER.
  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.
                                                           LBD02128-01-9

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