senate Bill S3542

2013-2014 Legislative Session

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law

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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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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to insurance
Feb 05, 2013 referred to insurance

Co-Sponsors

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S3542 - Bill Details

See Assembly Version of this Bill:
A7534
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3224-a, 3216, 3221 & 4303, Ins L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S2714B, A4093B
2009-2010: S4462, A10735

S3542 - Bill Texts

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Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.

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BILL NUMBER:S3542

TITLE OF BILL: An act to amend the insurance law, in relation to
payments to prehospital emergency medical services providers

PURPOSE: To ensure that responding ambulance service companies receive
direct payment for all ambulance service transports upon submission of
an invoice to the insurance company without the need for the responding
ambulance company to be a preferred provider.

SUMMARY OF PROVISIONS: Section 1 amends section 3224-a of the insurance
law to provide that payments made to nonparticipating or non-preferred
providers of ambulance services made by health insurers shall be done so
directly to the provider or jointly to both the provider and the
insured.

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of subsection
(i) of section 3216 of the insurance law stating that the insurers shall
send such payments directly to the provider of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of subsection
(1) of section 3221 of the insurance law stating that the insurers shall
send such payments directly to the provider of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities

Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that the insurers shall send such payments
directly to the provider of such ambulance services if the ambulance
service includes an executed assignment of benefits form with the claim
and the provisions of this paragraph shall apply to transfers of
patients between hospitals or health care facilities.

Section 5. Effective Date

JUSTIFICATION: The constant and quick availability of ambulance response
is something that all of our citizens have grown accustomed to and it is
essential to the survivability of all New Yorkers when there is a
medical crisis. Fair and direct reimbursement for those services is
paramount to the Financial stability and continued availability of ambu-
lances to respond.

Current law permits insurance companies to pay for ambulance service
charges direct to the patient until and unless the ambulance company
becomes a preferred provider of that specific insurance company. It is
not practical to expect a preferred provider relationship with every

insurance company. But then it is the responsibility of the ambulance
company to try to recoup payment for service from that patient

All types of EMS providers routinely are not paid by the patient for
ambulance services even though the patient receives payment from the
insurance company. Especially as the financial crisis we are currently
facing deepens, more and more patients are pocketing these funds.
Further, the insurance company is not obligated to advise the ambulance
company that they in fact paid the ambulance transport bill direct to
the patient. This disconnect of information leads to confusion and
furthers the lack of proper payment issue.

In New York State, ambulance companies are mandated responders. As such,
most ambulance providers have no knowledge of the patient's ability to
pay or if or by whom they are insured by when a medical emergency or
accidental event occurs. Ambulance service is one of the few medical
services where payment is not expected at the time of service.

This legislation will assure that responding ambulance service will
receive direct payment for all ambulance service transports upon
submission of an invoice to the insurance company without the need for
the responding ambulance company to be a preferred provider

LEGISLATIVE HISTORY: S.2714-B of 2011-12; S.4462 of 2010.

FISCAL IMPLICATIONS: None

EFFECTIVE DATE: This act shall take effect January 1, 2014 and shall
apply to health care claims submitted for payment after such date.

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

                                  3542

                       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 payments to  prehospi-
  tal emergency medical services providers

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

  Section 1. Section 3224-a of the insurance law is amended by adding  a
new subsection (j) to read as follows:
  (J)  PAYMENTS  TO  NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU-
LANCE SERVICES LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC  HEALTH  LAW.
(1)  WHENEVER  AN INSURER OR AN ORGANIZATION, OR CORPORATION LICENSED OR
CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER
OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW PROVIDES THAT ANY  HEALTH
CARE  CLAIMS  SUBMITTED  UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED
INTO PURSUANT TO THIS  ARTICLE  OR  ARTICLE  FORTY-TWO,  FORTY-THREE  OR
FORTY-SEVEN  OF THIS CHAPTER AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW ARE PAYABLE TO A PARTICIPATING OR PREFERRED  PROVIDER  OF  AMBULANCE
SERVICES  FOR  SERVICES  RENDERED,  THE INSURER, ORGANIZATION, OR CORPO-
RATION  LICENSED  OR  CERTIFIED  PURSUANT  TO  ARTICLE  FORTY-THREE   OR
FORTY-SEVEN  OF  THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW SHALL BE REQUIRED TO PAY SUCH BENEFITS EITHER DIRECTLY TO ANY  SIMI-
LARLY  LICENSED  NONPARTICIPATING  OR NONPREFERRED PROVIDER AT THE USUAL
AND CUSTOMARY CHARGE, WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE, WHEN
THE PROVIDER HAS RENDERED SUCH SERVICES, HAS  A  WRITTEN  ASSIGNMENT  OF
BENEFITS,  AND  HAS CAUSED WRITTEN NOTICE OF SUCH ASSIGNMENT TO BE GIVEN
TO THE INSURER,  ORGANIZATION,  OR  CORPORATION  LICENSED  OR  CERTIFIED
PURSUANT  TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTI-
CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR JOINTLY  TO  SUCH  NONPARTIC-
IPATING  OR  NONPREFERRED  PROVIDER  AND  TO THE INSURED, SUBSCRIBER, OR
OTHER COVERED PERSON; PROVIDED, HOWEVER, THAT IN EITHER CASE THE  INSUR-
ER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06549-02-3

S. 3542                             2

CLE  FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF
THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND  SUCH  BENEFIT  PAYMENTS
DIRECTLY TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT. WHEN PAYMENT IS
MADE  DIRECTLY TO A PROVIDER OF AMBULANCE SERVICES AS AUTHORIZED BY THIS
SECTION, THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED
PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR  ARTI-
CLE  FORTY-FOUR  OF  THE  PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF
SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
  (2)  AN  INSURER  SHALL  PROVIDE  REIMBURSEMENT  FOR  THOSE   SERVICES
PRESCRIBED  BY  THIS SECTION AT RATES NEGOTIATED BETWEEN THE INSURER AND
THE PROVIDER OF SUCH SERVICES. IN THE ABSENCE OF AGREED UPON  RATES,  AN
INSURER  SHALL  PAY FOR SUCH SERVICES AT THE USUAL AND CUSTOMARY CHARGE,
WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE.
  (3) NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO PROHIBIT  THE
PAYMENT  OF  DIFFERENT  LEVELS OF BENEFITS OR FROM HAVING DIFFERENCES IN
COINSURANCE  PERCENTAGES  APPLICABLE  TO  BENEFIT  LEVELS  FOR  SERVICES
PROVIDED BY PARTICIPATING OR PREFERRED PROVIDERS AND NONPARTICIPATING OR
NONPREFERRED PROVIDERS.
  THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO POLICIES THAT DO NOT
INCLUDE COVERAGE FOR AMBULANCE SERVICES.
  S  2.  Subparagraphs  (C) and (D) of paragraph 24 of subsection (i) of
section 3216 of the insurance law, as added by chapter 506 of  the  laws
of 2001, are amended to read as follows:
  (C)   An  insurer  shall  provide  reimbursement  for  those  services
prescribed by this section at rates negotiated between the  insurer  and
the  provider  of such services. In the absence of agreed upon rates, an
insurer shall pay for such services at the usual and  customary  charge,
which  shall  not  be excessive or unreasonable.  THE INSURER SHALL SEND
SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH  AMBULANCE  SERVICES,  IF
THE  AMBULANCE  SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM
WITH THE CLAIM.
  (D) The provisions of this paragraph  shall  have  no  application  to
transfers  of patients between hospitals or health care facilities by an
ambulance service as described in subparagraph  (A)  of  this  paragraph
UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY.
  S  3.  Subparagraphs  (C) and (D) of paragraph 15 of subsection (l) of
section 3221 of the insurance law, as added by chapter 506 of  the  laws
of 2001, are amended to read as follows:
  (C)   An  insurer  shall  provide  reimbursement  for  those  services
prescribed by this section at rates negotiated between the  insurer  and
the  provider  of such services. In the absence of agreed upon rates, an
insurer shall pay for such services at the usual and  customary  charge,
which  shall  not  be excessive or unreasonable.  THE INSURER SHALL SEND
SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH  AMBULANCE  SERVICES,  IF
THE  AMBULANCE  SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM
WITH THE CLAIM.
  (D) The provisions of this paragraph  shall  have  no  application  to
transfers  of patients between hospitals or health care facilities by an
ambulance service as described in subparagraph  (A)  of  this  paragraph
UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY.
  S  4.  Paragraphs  3  and  4 of subsection (aa) of section 4303 of the
insurance law, as added by chapter 506 of the laws of 2001, are  amended
to read as follows:
  (3)   An  insurer  shall  provide  reimbursement  for  those  services
prescribed by this section at rates negotiated between the  insurer  and
the  provider  of such services. In the absence of agreed upon rates, an

S. 3542                             3

insurer shall pay for such services at the usual and  customary  charge,
which  shall  not  be excessive or unreasonable.  THE INSURER SHALL SEND
SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH  AMBULANCE  SERVICES,  IF
THE  AMBULANCE  SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM
WITH THE CLAIM.
  (4) The provisions of this subsection shall  have  no  application  to
transfers  of patients between hospitals or health care facilities by an
ambulance service as described  in  paragraph  one  of  this  subsection
UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY.
  S  5.  This  act  shall take effect January 1, 2014 and shall apply to
health care claims submitted for payment after such date.

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