NY State Senate Bill 2021-S4787

Senate Bill S4787

2021-2022 Legislative Session

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

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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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 05, 2022	referred to insurance
Feb 12, 2021	referred to insurance

2021-S4787 (ACTIVE) - Details

See Assembly Version of this Bill:: A1983
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216 & 3221, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S7186, A9773, A8091
2011-2012: S1119, A495
2013-2014: S2637, A635
2015-2016: S1513, A7235
2017-2018: S3118, A2792
2019-2020: S4502, A2765
2023-2024: S5753, A2663

2021-S4787 (ACTIVE) - Summary

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery and such physician's services shall not be covered by their insurance policy; such services must be covered if the insured person does not receive notification prior to such services or procedure.

2021-S4787 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S4787

SPONSOR: PARKER
 
TITLE OF BILL:

An act to amend the insurance law, in relation to requiring notification
to insured persons that an out-of-network physician may be used in their
procedure, test or surgery

 
PURPOSE OR GENERAL IDEA OF BILL:

To provide notice to patients that services provided may not be covered
by health insurance.

 
SUMMARY OF SPECIFIC PROVISIONS:

To require notification whenever patient is using or about employ an
out-of-network physician and to informs the patient of the repercussion
of such. If the patient has not received such notification the insurer
shall cover the procedure.

 
JUSTIFICATION:

Very often out of network providers perform services to patients without
Patients being made aware that they will be responsible for payment for
such services as the provider is not a participating physician of the
patient's insurance carrier. An example would be an anesthesiologist who
meets a patient shortly before surgery. If the anesthesiologist is not a
participating provider, the patient will receive a bill and be responsi-
ble for payment. Had the anesthesiologist been a participating provider,
the Patient would only be responsible for a co-payment. If a patient is
informed who the provider will be before services are rendered they have
the opportunity to arrange for a different provider, one which partic-
ipates with their insurance plan.

 
PRIOR LEGISLATIVE HISTORY:

2019-20: S.4502/A2765 - Referred to Insurance

2017-18: S.3118/ A2792 - REFERRED TO INSURANCE

2015-16: S.1513/A.7235 - Referred to Insurance

2013-14: S.2637A - Referred to Insurance

2011-12: S.1119/A.495 - Referred to Insurance

2009-10: S.7186/A.9773 - Referred to Insurance

2007-08: A.101243

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2021-S4787 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4787
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             February 12, 2021
                                ___________
 
 Introduced  by  Sen.  PARKER -- 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 requiring notification
   to insured persons that an out-of-network physician  may  be  used  in
   their procedure, test or surgery

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 3216 of the insurance law is amended  by  adding  a
 new subsection (n) to read as follows:
   (N)  (1)  EVERY  PERSON  INSURED UNDER A POLICY OF ACCIDENT AND HEALTH
 INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE  ENTI-
 TLED  TO  NOTIFICATION  FROM  THE BILLING ENTITY PRIOR TO THE PROCEDURE,
 TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE  USED  IN  SUCH
 PROCEDURE,  TEST  OR  SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE
 COVERED BY THEIR INSURANCE POLICY.
   (2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN  SERVICES  SHALL  BE
 COVERED  BY  THE  INSURANCE POLICY OF AN INSURED PERSON IF HE OR SHE HAS
 NOT RECEIVED NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO  THE  HEALTH
 SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
   §  2.  Section  3221  of  the insurance law is amended by adding a new
 subsection (u) to read as follows:
   (U) (1) EVERY PERSON INSURED UNDER A POLICY  OF  ACCIDENT  AND  HEALTH
 INSURANCE  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE ENTI-
 TLED TO NOTIFICATION FROM THE BILLING ENTITY  PRIOR  TO  THE  PROCEDURE,
 TEST  OR  SURGERY,  THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE USED IN SUCH
 PROCEDURE, TEST OR SURGERY AND SUCH PHYSICIAN'S SERVICES  SHALL  NOT  BE
 COVERED BY THEIR INSURANCE POLICY.
   (2)  THE  PATIENT  COSTS OF OUT-OF-NETWORK PHYSICIAN SERVICES SHALL BE
 COVERED BY THE INSURANCE POLICY OF AN INSURED PERSON IF HE  OR  SHE  HAS
 NOT  RECEIVED  NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO THE HEALTH
 SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
   § 3. This act shall take effect immediately.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD04786-01-1

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