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; provides such services must be covered if the insured person does not receive notification prior to such services or procedure.
S T A T E O F N E W Y O R K
________________________________________________________________________
3488
2025-2026 Regular Sessions
I N A S S E M B L Y
January 28, 2025
___________
Introduced by M. of A. DILAN -- read once and referred 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 THEY HAVE 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 (v) to read as follows:
(V) (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 THEY HAVE 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.
Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.
Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.
Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.