Senate Bill S9077

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9077
 
                             I N  S E N A T E
 
                               June 15, 2018
                                ___________
 
 Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the insurance law, in relation to  patient  billing  for
   emergency services
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subsection (c) of section 3241 of  the  insurance  law,  as
 added  by  section  6  of  part  H of chapter 60 of the laws of 2014, is
 amended to read as follows:
   (c) (1) When an insured or enrollee under a contract  or  policy  that
 provides  coverage  for  emergency services receives the services from a
 health care provider that does not participate in the  provider  network
 of  an  insurer, a corporation organized pursuant to article forty-three
 of this chapter, a municipal cooperative health benefit  plan  certified
 pursuant  to  article  forty-seven of this chapter, a health maintenance
 organization certified pursuant to  article  forty-four  of  the  public
 health  law, or a student health plan established or maintained pursuant
 to section one thousand one hundred twenty-four of this chapter ("health
 care plan"), the health care plan shall: (A) ensure that the insured  or
 enrollee  shall  incur  no greater out-of-pocket costs for the emergency
 services than the insured or enrollee would have incurred with a  health
 care  provider  that  participates  in  the  health care plan's provider
 network; AND (B) PROVIDE THE INSURED OR ENROLLEE THE OPTION OF ASSIGNING
 THE PAYMENT OF ANY BENEFITS DUE UNDER SUCH CONTRACT OR  POLICY  DIRECTLY
 TO  THE  HEALTH  CARE PROVIDER. WHENEVER, IN ANY HEALTH INSURANCE CLAIMS
 FORM, AN INSURED OR ENROLLEE  SPECIFICALLY  AUTHORIZES  THE  PAYMENT  OF
 BENEFITS  DIRECTLY  TO  A HEALTH CARE PROVIDER, THE HEALTH CARE PROVIDER
 SHALL SUBMIT CLAIMS FOR BENEFITS TO THE  HEALTH CARE PLAN AND THE HEALTH
 CARE PLAN SHALL MAKE PAYMENT FOR ANY BENEFITS TO THE HEALTH CARE PROVID-
 ER.
   (2) WHENEVER  AN  INSURED  OR  ENROLLEE  SPECIFICALLY  AUTHORIZES  THE
 PAYMENT  OF BENEFITS DIRECTLY TO A HEALTH CARE PROVIDER, THE HEALTH CARE
 PROVIDER SHALL NOT   BILL THE INSURED OR ENROLLEE  FOR  PAYMENT  OF  ANY
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD16065-02-8

 S. 9077                             2
 
 AMOUNT  OTHER THAN ANY APPLICABLE  COPAYMENT, COINSURANCE AND/OR DEDUCT-
 IBLE UNLESS THE HEALTH PLAN FAILS TO HONOR AN ASSIGNMENT OF BENEFITS.
   (3)  THE  HEALTH  CARE  PROVIDER SHALL NOT FURTHER BILL THE INSURED OR
 ENROLLEE FOR ANY REMAINING BALANCE ONCE THE HEALTH CARE  PLAN  HAS  MADE
 ITS INITIAL PAYMENT FOR WHICH THE INSURED OR ENROLLEE MUST BE HELD HARM-
 LESS BY THE HEALTH PLAN, BUT SHALL, WITH NOTICE TO THE INSURED OR ENROL-
 LEE OF THE EXISTING BALANCE, RESUBMIT THE BALANCE TO THE HEALTH PLAN. IN
 THE  EVENT  AN  INSURED  OR ENROLLEE MISTAKENLY REIMBURSES A HEALTH CARE
 PROVIDER FOR EMERGENCY SERVICES FOR WHICH THE INSURED  OR  ENROLLEE  HAS
 ASSIGNED   PAYMENT  OF  BENEFITS  PURSUANT  TO  PARAGRAPH  ONE  OF  THIS
 SUBSECTION, THE HEALTH CARE PROVIDER SHALL PROMPTLY REFUND SUCH PAYMENT,
 LESS ANY APPLICABLE COPAYMENT, COINSURANCE  AND/OR  DEDUCTIBLE,  TO  THE
 INSURED OR ENROLLEE.
   For  the  purpose of this section, "emergency services" shall have the
 meaning set forth in subparagraph (D) of paragraph  nine  of  subsection
 (i)  of  section  three  thousand  two  hundred sixteen of this article,
 subparagraph (D) of paragraph four of subsection (k)  of  section  three
 thousand two hundred twenty-one of this article, and subparagraph (D) of
 paragraph  two  of subsection (a) of section four thousand three hundred
 three of this chapter.
   § 2. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.