BILL NUMBER: S9702

SPONSOR: ADDABBO
 
TITLE OF BILL:

An act to amend the insurance law, in relation to prohibiting the retro-
spective denial of payment for substance use disorder treatment services

 
PURPOSE:

This bill will prohibit insurers from retrospectively denying payment
for substance use disorder treatment services for which the provider
verified the insured had coverage at the time such treatment was initi-
ated.

 
SUMMARY OF PROVISIONS:

§ 1 The insurance law is amended by adding a new section 3246 - Retro-
spective denial of payment of substance use disorder treatment services.

§ 2 Establishes the effective date.

              

 
JUSTIFICATION:

New York State is in an unprecedented crisis as it relates to addiction.
Recent data shows that every day, 19 New Yorkers die from opioid over-
dose and 18 additional New Yorkers die from alcohol abuse. This means we
are losing 37 individuals every single day to substance use disorder.
While substance use disorder treatment providers are working tirelessly
to change the trajectory of lives lost, their payments for providing
services are unstable. Currently, payments for services provided are
being retroactively taken back by insurance companies, threatening the
sustainability of the sector.  Payments are taken back from providers
(retroactively, and sometimes years later) for patients who have already
received services that were medically necessary and approved by the
insurer. When a provider follows the insurers preauthorization approval
process and other contractual requirements for a patient to receive care
- the insurer should have no ability to take back such payments absent
fraud. New York State must do what it takes to rein in arbitrary, unfair
and no-accountability insurance claw backs that are hampering the treat-
ment community's ability to provide its patients with life-saving treat-
ments. This blatantly unfair practice is commonplace and must end. It is
putting addiction treatment professionals in the impossible position of
having to shutter their programs at a time when overdose deaths and
addiction-related health needs have never been greater.

 
PRIOR LEGISLATIVE HISTORY:

New Bill.

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act shall take effect immediately,