Senate Bill S5157

2009-2010 Legislative Session

Prohibits an insurer from preventing an insured from assigning his or her right to reimbursement for out-of-network services to such service provider

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2010	referred to insurance
Apr 27, 2009	referred to insurance

co-Sponsors

2009-S5157 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3217-b & 4325, Ins L; amd §4406-c, Pub Health L

2009-S5157 (ACTIVE) - Summary

Prohibits an insurer from preventing an insured from assigning his or her right to reimbursement for out-of-network services to such service provider.

2009-S5157 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S5157

 TITLE OF BILL :  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

 PURPOSE :  This bill would amend the insurance and public health laws
to prohibit an insurer from preventing an insured from assigning his
or her right to reimbursement for out-of-network services to a
provider of services such as a physician or hospital

 SUMMARY OF PROVISIONS :  Section one (1) and two (2) amend sections
3217-b and 4325 of the insurance law, respectively, as amended by
chapter 586 of the laws of 1998, to include a new subsection (g) which
states that no insurer 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, and provide the insured
patient with written notification delineating the payment. Section (3)
includes a new subdivision 6 of section 4406-c of the public health
law, which states that no insurer 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, and
provide the insured patient with written notification delineating the
payment.

 JUSTIFICATION :  Under current law, HMO's and insurance companies are
not required to make direct reimbursement payments to an out-of
network provider for medical services rendered, even upon the request
of the insured patient.  Out-of-network physicians and hospitals
attending to insured patients are often obliged to place themselves in
a precarious financial position. Providers are expected to obtain
reimbursement from the patients themselves, who are much less likely
to pay for the services after they have been rendered. An insurer's
refusal to pay out-of-network providers directly imposes undue
financial risk on the health care provider, makes them less likely to
accept these patients to begin with, and unduly pressures
out-of-network providers to accept lower rates and participate in the
in-network benefits portion of the insurer's network.

 LEGISLATIVE HISTORY: :  2008-07S.5183/ REFERRED TO INSURANCE

 FISCAL IMPLICATIONS ::None

 EFFECTIVE DATE :  This act shall take effect on the sixtieth day
after it shall have become law and shall apply to any insurance
contract entered into, amended or modified on or after such effective
date.

2009-S5157 (ACTIVE) - Bill Text download pdf

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

                                  5157

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 27, 2009
                               ___________

Introduced  by  Sen. MORAHAN -- read twice and ordered printed, and when
  printed to be committed 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
INSURANCE CONTRACT TO AN OUT-OF-NETWORK SERVICE PROVIDER. IF THE INSURER

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

S. 5157                             2

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.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Find your Senator and share your views on important issues.

Do you support this bill?

Senate Bill S5157

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

co-Sponsors

2009-S5157 (ACTIVE) - Details

2009-S5157 (ACTIVE) - Summary

2009-S5157 (ACTIVE) - Sponsor Memo

2009-S5157 (ACTIVE) - Bill Text download pdf

Comments

Do you support this bill?

Get Status Alerts for 2009-S5157

Senate Bill S5157

Share this bill

Sponsored By

Thomas P. Morahan

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

co-Sponsors

Owen H. Johnson

2009-S5157 (ACTIVE) - Details

2009-S5157 (ACTIVE) - Summary

2009-S5157 (ACTIVE) - Sponsor Memo

2009-S5157 (ACTIVE) - Bill Text download pdf

Comments