senate Bill S3568

2017-2018 Legislative Session

Limits denial of coverage of additional treatment related to health care services for which pre-authorization is required and was granted

download bill text pdf

Sponsored By

Current Bill Status - In Senate Committee Insurance Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

view actions (2)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 03, 2018 referred to insurance
Jan 24, 2017 referred to insurance

S3568 - Details

See Assembly Version of this Bill:
A1129
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §3238, Ins L
Versions Introduced in 2015-2016 Legislative Session:
S7558, A10268

S3568 - Summary

Limits denial of coverage of additional treatment related to health care services for which pre-authorization is required and was granted.

S3568 - Sponsor Memo

S3568 - Bill Text download pdf


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

                                  3568

                       2017-2018 Regular Sessions

                            I N  S E N A T E

                            January 24, 2017
                               ___________

Introduced  by  Sen.  HANNON -- 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 denial of coverage  of
  treatment  related to health care services for which pre-authorization
  was granted

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

  Section  1.  Section  3238 of the insurance law is amended by adding a
new subsection (c-1) to read as follows:
  (C-1) IF A HEALTH PLAN DENIES PAYMENT FOR THE TREATMENT OF  CONCURRENT
SYMPTOMS  OR  SIDE  EFFECTS  DUE  TO  LACK OF PRE-AUTHORIZATION AND SUCH
TREATMENT IS RENDERED AT THE SAME TIME AS  A  HEALTH  CARE  SERVICE  FOR
WHICH  PRE-AUTHORIZATION  WAS  REQUIRED AND RECEIVED, UPON THE APPEAL OF
THE DENIAL, THE DENIAL OF ANY SUCH SERVICE SHALL BE UPHELD ONLY IF IT IS
DETERMINED THAT:
  (1) THE TREATMENT IS NOT A COVERED BENEFIT;
  (2) THE TREATMENT WAS NOT MEDICALLY NECESSARY PURSUANT TO SECTION FOUR
THOUSAND NINE HUNDRED FOUR OF THIS CHAPTER OR SECTION FORTY-NINE HUNDRED
FOUR OF THE PUBLIC HEALTH LAW;
  (3) THE TREATMENT WAS  EXPERIMENTAL  OR  INVESTIGATIONAL  PURSUANT  TO
SECTION  FOUR  THOUSAND  NINE  HUNDRED  FOUR  OF THIS CHAPTER OR SECTION
FORTY-NINE HUNDRED FOUR OF THE PUBLIC HEALTH LAW; OR
  (4) ONE OF THE CONDITIONS SET FORTH IN PARAGRAPHS ONE THROUGH  SIX  OF
SUBSECTION (A) OF THIS SECTION IS MET.
  §  2.  This  act shall take effect on the ninetieth day after it shall
have become a law.


 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02613-01-7

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