senate Bill S3541

2013-2014 Legislative Session

Relates to reimbursement for ambulance services

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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
Jan 08, 2014 referred to insurance
Feb 05, 2013 referred to insurance

Co-Sponsors

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S3541 - Bill Details

See Assembly Version of this Bill:
A3707
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L
Versions Introduced in 2011-2012 Legislative Session:
S6982, A10091

S3541 - Bill Texts

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Relates to reimbursement for ambulance services.

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BILL NUMBER:S3541

TITLE OF BILL: An act to amend the insurance law, in relation to
reimbursement for ambulance services

PURPOSE: To require insurers to submit payments directly to ambulance
providers who are in-network or, for out-of-network ambulance providers,
to require the issuance of a joint check to the insured specifying both
the insured and the ambulance provider as payees.

SUMMARY OF PROVISIONS: Amends sections 3216(i)(24), 3221(1)(15) and
4303(aa) to require insurers to submit payments directly to in-network
ambulance providers at the negotiated rates For out-of-network ambulance
providers where there is no negotiated rate, the insurer is required to
issue a joint check to the insured specifying both the insured and ambu-
lance provider as payees, at the usual and customary charge.

Further, the legislation requires the insurer to issue reimbursement
directly to the ambulance provider if the insured has filed an assign-
ment of benefits for such ambulance services.

The legislation also requires the insurer to notify the ambulance
provider electronically upon the issuance of a joint check to the
insured. The notification must include the name of the patient, date of
service, date of payment, amount of payment and address to which the
payment was sent.

JUSTIFICATION: This bill would amend the insurance law to require insur-
ers to issue joint signature checks to both the patient and ambulance
service provider when the patient utilizes an ambulance service provider
that is a non-participating provider of their network.

Currently, when a patient uses an out-of-network ambulance provider,
their insurance company will send the ambulance reimbursement payment
directly to the patient. The patient is then expected to forward that
reimbursement payment to the ambulance service that provided the
service. In many cases with a single signature check, the patients never
send the insurance reimbursement to the service provider. Rather, they
keep the money for themselves, diverting millions of dollars from our
healthcare system in the process.

This bill would insure that healthcare dollars stay in the healthcare
system and that healthcare providers are paid for the work that they do.
In order to cash the check, both parties would need to endorse the
check. Insurers would send the joint signature check to the patient, the
patient would sign it and send it to the ambulance provider The ambu-
lance provider could then endorse the check and be paid for their
service. The insurer will also notify the ambulance provider when a
joint signature check has been sent to the patient.

Ambulance providers are mandated responders who must provider service
when an emergency call comes in. They answer these calls without know-
ledge of a patient's ability to pay and without concern of getting paid
at the time of service But in order to keep the ambulance system strong
and viable they must collect payment for service. This bill would assist
in collecting payments.

LEGISLATIVE HISTORY: S.6982 of 2012

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately.

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

                                  3541

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            February 5, 2013
                               ___________

Introduced  by  Sen.  SEWARD -- 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  reimbursement  for
  ambulance services

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

  Section 1. Paragraph 24 of subsection  (i)  of  section  3216  of  the
insurance  law  is  amended  by adding a new subparagraph (F) to read as
follows:
  (F) AN INSURER WHO ISSUES REIMBURSEMENT  UNDER  THIS  PARAGRAPH  SHALL
SUBMIT  SUCH PAYMENTS EITHER DIRECTLY TO THE PROVIDER AT THE RATES NEGO-
TIATED BETWEEN THE PROVIDER AND THE INSURER, OR IF NO    RATE  HAS  BEEN
NEGOTIATED  BETWEEN THE PROVIDER AND INSURER, THEN TO THE INSURED IN THE
FORM OF A JOINT CHECK SPECIFYING AS PAYEES  BOTH  THE  INSURED  AND  THE
PROVIDER OF AMBULANCE SERVICES, AT THE USUAL AND CUSTOMARY CHARGE, WHICH
SHALL NOT BE EXCESSIVE OR UNREASONABLE; PROVIDED HOWEVER, IF THE PROVID-
ER OF AMBULANCE SERVICES HAS ON FILE A DULY EXECUTED ASSIGNMENT OF BENE-
FITS  FOR  SUCH  SERVICES  TO  THE  INSURER,  NOTWITHSTANDING ANY POLICY
LANGUAGE TO THE CONTRARY, THE ISSUER SHALL  ACCEPT  SUCH  ASSIGNMENT  OF
BENEFITS AND THE INSURER SHALL ISSUE REIMBURSEMENT SOLELY TO THE PROVID-
ER. AN INSURER ISSUING PAYMENT IN THE FORM OF A JOINT CHECK SHALL NOTIFY
THE  PROVIDER  VIA  ELECTRONIC  COMMUNICATION  OF  THE  ISSUANCE OF SUCH
PAYMENT. THE NOTIFICATION SHALL INCLUDE THE NAME  OF  THE  PATIENT,  THE
DATE  OF  SERVICE,  THE  DATE  OF PAYMENT, THE AMOUNT OF PAYMENT AND THE
ADDRESS TO WHICH THE PAYMENT WAS SENT.
  S 2.  Paragraph 15 of subsection (1) of section 3221 of the  insurance
law is amended by adding a new subparagraph (F) to read as follows:
  (F)  AN  INSURER  WHO  ISSUES REIMBURSEMENT UNDER THIS PARAGRAPH SHALL
SUBMIT SUCH PAYMENTS EITHER DIRECTLY TO THE PROVIDER AT THE RATES  NEGO-
TIATED  BETWEEN  THE  PROVIDER  AND  THE INSURER, OR IF NO RATE HAS BEEN
NEGOTIATED BETWEEN THE PROVIDER AND INSURER, THEN TO THE INSURED IN  THE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07580-01-3

S. 3541                             2

FORM  OF  A  JOINT  CHECK  SPECIFYING AS PAYEES BOTH THE INSURED AND THE
PROVIDER OF AMBULANCE SERVICES, AT THE USUAL AND CUSTOMARY CHARGE, WHICH
SHALL NOT BE EXCESSIVE OR UNREASONABLE; PROVIDED HOWEVER, IF THE PROVID-
ER OF AMBULANCE SERVICES HAS ON FILE A DULY EXECUTED ASSIGNMENT OF BENE-
FITS  FOR  SUCH  SERVICES  TO  THE  INSURER,  NOTWITHSTANDING ANY POLICY
LANGUAGE TO THE CONTRARY, THE INSURER SHALL ACCEPT  SUCH  ASSIGNMENT  OF
BENEFITS AND THE INSURER SHALL ISSUE REIMBURSEMENT SOLELY TO THE PROVID-
ER. AN INSURER ISSUING PAYMENT IN THE FORM OF A JOINT CHECK SHALL NOTIFY
THE  PROVIDER  VIA  ELECTRONIC  COMMUNICATION  OF  THE  ISSUANCE OF SUCH
PAYMENT. THE NOTIFICATION SHALL INCLUDE THE NAME  OF  THE  PATIENT,  THE
DATE  OF  SERVICE,  THE  DATE  OF PAYMENT, THE AMOUNT OF PAYMENT AND THE
ADDRESS TO WHICH THE PAYMENT WAS SENT.
  S 3. Subsection (aa) of section 4303 of the insurance law  is  amended
by adding a new paragraph 6 to read as follows:
  (6)  AN  INSURER  WHO  ISSUES REIMBURSEMENT UNDER THIS PARAGRAPH SHALL
SUBMIT SUCH PAYMENTS EITHER DIRECTLY TO THE PROVIDER AT THE RATES  NEGO-
TIATED  BETWEEN  THE  PROVIDER  AND  THE INSURER, OR IF NO RATE HAS BEEN
NEGOTIATED BETWEEN THE PROVIDER AND INSURER, THEN TO THE INSURED IN  THE
FORM  OF  A  JOINT  CHECK  SPECIFYING AS PAYEES BOTH THE INSURED AND THE
PROVIDER OF AMBULANCE SERVICES, AT THE USUAL AND CUSTOMARY CHARGE, WHICH
SHALL NOT BE EXCESSIVE OR UNREASONABLE; PROVIDED HOWEVER, IF THE PROVID-
ER OF AMBULANCE SERVICES HAS ON FILE A DULY EXECUTED ASSIGNMENT OF BENE-
FITS FOR SUCH  SERVICES  TO  THE  INSURER,  NOTWITHSTANDING  ANY  POLICY
LANGUAGE  TO  THE  CONTRARY, THE INSURER SHALL ACCEPT SUCH ASSIGNMENT OF
BENEFITS AND THE INSURER SHALL ISSUE REIMBURSEMENT SOLELY TO THE PROVID-
ER. AN INSURER ISSUING PAYMENT IN THE FORM OF A JOINT CHECK SHALL NOTIFY
THE PROVIDER VIA  ELECTRONIC  COMMUNICATION  OF  THE  ISSUANCE  OF  SUCH
PAYMENT.  THE  NOTIFICATION  SHALL  INCLUDE THE NAME OF THE PATIENT, THE
DATE OF SERVICE, THE DATE OF PAYMENT, THE  AMOUNT  OF  PAYMENT  AND  THE
ADDRESS TO WHICH THE PAYMENT WAS SENT.
  S 4. This act shall take effect immediately.

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