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Assembly Bill A1825

2021-2022 Legislative Session

Directs a health maintenance organization which denies a claim due to absence of medical necessity to advise insured as to alternative treatment

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Archive: Last Bill Status - In Assembly Committee

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2021-A1825 (ACTIVE) - Details

Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Add §2601-a, Ins L
Versions Introduced in Other Legislative Sessions:
2009-2010: A2571
2011-2012: A2843
2013-2014: A3505
2015-2016: A1942
2017-2018: A766
2019-2020: A4103
2023-2024: A4772
2025-2026: A7292

2021-A1825 (ACTIVE) - Summary

Directs a health maintenance organization which denies claim due to absence of medical necessity to inform insured as to preferred alternative treatment, or provide the insured with a statement as to the past ineffectiveness of the requested procedure or treatment.

2021-A1825 (ACTIVE) - Bill Text download pdf 

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1825
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 11, 2021
                                ___________
 
 Introduced  by M. of A. PRETLOW -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the insurance law, in relation to notice by health main-
   tenance organizations that a request  for  coverage  of  a  particular
   treatment is denied
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new section 2601-a
 to read as follows:
   § 2601-A. DENIAL OF COVERAGE OR  TREATMENT  BY  A  HEALTH  MAINTENANCE
 ORGANIZATION. WHENEVER A HEALTH MAINTENANCE ORGANIZATION, DOING BUSINESS
 IN  THIS STATE, DENIES A CLAIM FOR COVERAGE OF A PARTICULAR PROCEDURE OR
 TREATMENT BECAUSE SUCH PROCEDURE OR TREATMENT IS  NOT  MEDICALLY  NECES-
 SARY, THE HEALTH MAINTENANCE ORGANIZATION SHALL INFORM THE INSURED AS TO
 THOSE  PREFERRED  PROCEDURE OR TREATMENT OPTIONS WHICH WOULD BE COVERED,
 OR PROVIDE THE INSURED WITH A STATEMENT AS TO THE  PAST  INEFFECTIVENESS
 OF THE REQUESTED PROCEDURE OR TREATMENT.
   §  2.  This  act shall take effect on the thirtieth day after it shall
 have become a law.
 
 
 
 
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD00242-01-1

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