Senate Bill S1394

2019-2020 Legislative Session

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

download bill text pdf

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Archive: Last Bill Status - Stricken


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2019-S1394 (ACTIVE) - Details

See Assembly Version of this Bill:
A2880
Law Section:
Insurance Law
Laws Affected:
Amd §3238, Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: S7558, A10268
2017-2018: S3568, A1129

2019-S1394 (ACTIVE) - Summary

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

2019-S1394 (ACTIVE) - Sponsor Memo

2019-S1394 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1394
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                             January 14, 2019
                                ___________
 
 Introduced  by  Sen.  RIVERA -- 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.
                                                            LBD04761-01-9



              

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