senate Bill S2637A

2013-2014 Legislative Session

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery

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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
Feb 10, 2014 print number 2637a
amend and recommit to insurance
Jan 08, 2014 referred to insurance
Jan 23, 2013 referred to insurance

Bill Amendments

Original
A (Active)
Original
A (Active)

S2637 - Bill Details

Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216 & 3221, Ins L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S1119
2009-2010: A8091, S7186

S2637 - Bill Texts

view summary

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery and such physician's services shall not be covered by their insurance policy; such services must be covered if the insured person does not receive notification prior to such services or procedure.

view sponsor memo
BILL NUMBER:S2637

TITLE OF BILL:
An act
to amend the insurance law, in relation to requiring notification to
insured persons
that an out-of-network physician may be used in their
procedure, test or surgery

PURPOSE OR GENERAL IDEA OF BILL:
To provide notice to patients that services provided may not be
covered by health insurance.

SUMMARY OF SPECIFIC PROVISIONS:

Section 3216 of the insurance law is amended by adding a new
subsection (m); and Section 3221 of the insurance law is amended by
adding a new subsection (s).

JUSTIFICATION:
Very often out of network providers perform services to patients
without Patients being made aware that they will be responsible for
payment for such services as the provider is not a participating
physician of the patient's insurance carrier. An example would be an
anesthesiologist who meets a patient shortly before surgery. If the
anesthesiologist is not a participating provider, the patient will
receive a bill and be responsible for payment. Had the
anesthesiologist been a participating provider, the patient would
only be responsible for a co-payment. If a patient is informed who
the provider will be before services are rendered they have the
opportunity to arrange for a different provider, one which
participates with their insurance plan.

PRIOR LEGISLATIVE HISTORY:
2011-12: S.1119/A.495 - Referred to Insurance
2009-10: S.7186/A.9773 - Referred to Insurance
2007-08: A.10124B

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE:
This act shall take effect immediately.

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

                                  2637

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 23, 2013
                               ___________

Introduced  by  Sen.  PARKER -- 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 requiring notification
  to insured persons that an out-of-network physician  may  be  used  in
  their procedure, test or surgery

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

  Section 1. Section 3216 of the insurance law is amended  by  adding  a
new subsection (m) to read as follows:
  (M)  (1)  EVERY  PERSON  INSURED UNDER A POLICY OF ACCIDENT AND HEALTH
INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE  ENTI-
TLED  TO  NOTIFICATION  FROM  THE BILLING ENTITY PRIOR TO THE PROCEDURE,
TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE  USED  IN  SUCH
PROCEDURE,  TEST  OR  SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE
COVERED BY THEIR INSURANCE POLICY.
  (2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN  SERVICES  SHALL  BE
COVERED  BY  THE  INSURANCE POLICY OF AN INSURED PERSON IF HE OR SHE HAS
NOT RECEIVED NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO  THE  HEALTH
SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
  S  2.  Section  3221  of  the insurance law is amended by adding a new
subsection (s) to read as follows:
  (S) (1) EVERY PERSON INSURED UNDER A POLICY  OF  ACCIDENT  AND  HEALTH
INSURANCE  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE ENTI-
TLED TO NOTIFICATION FROM THE BILLING ENTITY  PRIOR  TO  THE  PROCEDURE,
TEST  OR  SURGERY,  THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE USED IN SUCH
PROCEDURE, TEST OR SURGERY AND SUCH PHYSICIAN'S SERVICES  SHALL  NOT  BE
COVERED BY THEIR INSURANCE POLICY.
  (2)  THE  PATIENT  COSTS OF OUT-OF-NETWORK PHYSICIAN SERVICES SHALL BE
COVERED BY THE INSURANCE POLICY OF AN INSURED PERSON IF HE  OR  SHE  HAS
NOT  RECEIVED  NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO THE HEALTH
SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
  S 3. This act shall take effect immediately.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02013-01-3

S2637A (ACTIVE) - Bill Details

Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216 & 3221, Ins L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S1119
2009-2010: A8091, S7186

S2637A (ACTIVE) - Bill Texts

view summary

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery and such physician's services shall not be covered by their insurance policy; such services must be covered if the insured person does not receive notification prior to such services or procedure.

view sponsor memo
BILL NUMBER:S2637A

TITLE OF BILL: An act to amend the insurance law, in relation to
requiring notification to insured persons that an out-of-network
physician may be used in their procedure, test or surgery

PURPOSE OR GENERAL IDEA OF BILL:

To provide notice to patients that services provided may not be
covered by health insurance.

SUMMARY OF SPECIFIC PROVISIONS:

Section 3216 of the insurance law is amended by adding a new
subsection (n); and Section 3221 of the insurance law is amended by
adding anew subsection (t).

JUSTIFICATION:

Very often out of network providers perform services to patients
without Patients being made aware that they will be responsible for
payment for such services as the provider is not a participating
physician of the patient's insurance carrier. An example would be an
anesthesiologist who meets a patient shortly before surgery. If the
anesthesiologist is not a participating provider, the patient will
receive a bill and be responsible for payment. Had the
anesthesiologist been a participating provider, the Patient would only
be responsible for a co-payment. If a patient is informed who the
provider will be before services are rendered they have the
opportunity to arrange for a different provider, one which
participates with their insurance plan.

PRIOR LEGISLATIVE HISTORY:

2011-12: S.1119/A.495 - Referred to Insurance
2009-10: S.7186/A.9773 - Referred to Insurance
2007-08: A.10124B

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

This act shall take effect immediately.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2637--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 23, 2013
                               ___________

Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance  --  recommitted
  to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted to said committee

AN ACT to amend the insurance law, in relation to requiring notification
  to insured persons that an out-of-network physician  may  be  used  in
  their procedure, test or surgery

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

  Section 1. Section 3216 of the insurance law is amended  by  adding  a
new subsection (n) to read as follows:
  (N)  (1)  EVERY  PERSON  INSURED UNDER A POLICY OF ACCIDENT AND HEALTH
INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE  ENTI-
TLED  TO  NOTIFICATION  FROM  THE BILLING ENTITY PRIOR TO THE PROCEDURE,
TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE  USED  IN  SUCH
PROCEDURE,  TEST  OR  SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE
COVERED BY THEIR INSURANCE POLICY.
  (2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN  SERVICES  SHALL  BE
COVERED  BY  THE  INSURANCE POLICY OF AN INSURED PERSON IF HE OR SHE HAS
NOT RECEIVED NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO  THE  HEALTH
SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
  S  2.  Section  3221  of  the insurance law is amended by adding a new
subsection (t) to read as follows:
  (T) (1) EVERY PERSON INSURED UNDER A POLICY  OF  ACCIDENT  AND  HEALTH
INSURANCE  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE ENTI-
TLED TO NOTIFICATION FROM THE BILLING ENTITY  PRIOR  TO  THE  PROCEDURE,
TEST  OR  SURGERY,  THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE USED IN SUCH
PROCEDURE, TEST OR SURGERY AND SUCH PHYSICIAN'S SERVICES  SHALL  NOT  BE
COVERED BY THEIR INSURANCE POLICY.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02013-02-4

S. 2637--A                          2

  (2)  THE  PATIENT  COSTS OF OUT-OF-NETWORK PHYSICIAN SERVICES SHALL BE
COVERED BY THE INSURANCE POLICY OF AN INSURED PERSON IF HE  OR  SHE  HAS
NOT  RECEIVED  NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO THE HEALTH
SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
  S 3. This act shall take effect immediately.

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