S T A T E O F N E W Y O R K
________________________________________________________________________
7298
2025-2026 Regular Sessions
I N A S S E M B L Y
March 25, 2025
___________
Introduced by M. of A. WOERNER -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the financial services law, in relation to including
ambulance services to the emergency room as part of emergency services
for the purposes of surprise bills
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (b) of section 603 of the financial services
law, as added by section 26 of part H of chapter 60 of the laws of 2014,
is amended to read as follows:
(b) "Emergency services" means, with respect to an emergency condi-
tion: (1) a medical screening examination as required under section
1867 of the social security act, 42 U.S.C. § 1395dd, which is within the
capability of the emergency department of a hospital, including ancil-
lary services routinely available to the emergency department to evalu-
ate such emergency medical condition; [and] (2) within the capabilities
of the staff and facilities available at the hospital, such further
medical examination and treatment as are required under section 1867 of
the social security act, 42 U.S.C. § 1395dd, to stabilize the patient;
AND (3) PUBLIC OR PRIVATE AMBULANCE SERVICES TO THE EMERGENCY ROOM FOR
TREATMENT OF AN EMERGENCY CONDITION.
§ 2. Paragraphs 1 and 2 of subsection (a) of section 605 of the finan-
cial services law, as amended by section 5 of subpart A of part AA of
chapter 57 of the laws of 2022, are amended to read as follows:
(1) When a health care plan receives a bill for emergency services
from a non-participating provider, including a bill for AMBULANCE
SERVICES OR inpatient services which follow an emergency room visit, the
health care plan shall pay an amount that it determines is reasonable
for the emergency services, including AMBULANCE SERVICES OR inpatient
services which follow an emergency room visit, rendered by the non-par-
ticipating provider, in accordance with section three thousand two
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11139-01-5
A. 7298 2
hundred twenty-four-a of the insurance law, except for the insured's
co-payment, coinsurance or deductible, if any, and shall ensure that the
insured shall incur no greater out-of-pocket costs for the emergency
services, including AMBULANCE SERVICES OR inpatient services which
follow an emergency room visit, than the insured would have incurred
with a participating provider. The non-participating provider may bill
the health care plan for the services rendered. Upon receipt of the
bill, the health care plan shall pay the non-participating provider the
amount prescribed by this section and any subsequent amount determined
to be owed to the provider in relation to the emergency services
provided, including AMBULANCE SERVICES OR inpatient services which
follow an emergency room visit.
(2) A non-participating provider or a health care plan may submit a
dispute regarding a fee or payment for emergency services, including
AMBULANCE SERVICES OR inpatient services which follow an emergency room
visit, for review to an independent dispute resolution entity.
§ 2-a. Paragraphs 1 and 2 of subsection (a) of section 605 of the
financial services law, as amended by section 13 of subpart A of part II
of chapter 57 of the laws of 2023, are amended to read as follows:
(1) When a health care plan receives a bill for emergency services
from a non-participating provider, including a bill for AMBULANCE
SERVICES OR inpatient services which follow an emergency room visit, or
a bill for services from a mobile crisis intervention services provider
licensed, certified, or designated by the office of mental health or the
office of addiction services and supports, the health care plan shall
pay an amount that it determines is reasonable for the emergency
services, including AMBULANCE SERVICES OR inpatient services which
follow an emergency room visit or for the mobile crisis intervention
services, rendered by the non-participating provider, in accordance with
section three thousand two hundred twenty-four-a of the insurance law,
except for the insured's co-payment, coinsurance or deductible, if any,
and shall ensure that the insured shall incur no greater out-of-pocket
costs for the emergency services, including AMBULANCE SERVICES OR inpa-
tient services which follow an emergency room visit or for the mobile
crisis intervention services, than the insured would have incurred with
a participating provider. The non-participating provider may bill the
health care plan for the services rendered. Upon receipt of the bill,
the health care plan shall pay the non-participating provider the amount
prescribed by this section and any subsequent amount determined to be
owed to the provider in relation to the emergency services provided,
including AMBULANCE SERVICES OR inpatient services which follow an emer-
gency room visit or for the mobile crisis intervention services.
(2) A non-participating provider or a health care plan may submit a
dispute regarding a fee or payment for emergency services, including
AMBULANCE SERVICES OR inpatient services which follow an emergency room
visit, or for services rendered by a mobile crisis intervention services
provider licensed, certified, or designated by the office of mental
health or the office of addiction services and supports, for review to
an independent dispute resolution entity.
§ 3. Paragraph 1 of subsection (b) of section 605 of the financial
services law, as amended by section 2 of part YY of chapter 56 of the
laws of 2020, is amended to read as follows:
(1) A patient that is not an insured or the patient's physician may
submit a dispute regarding a fee for emergency services, including AMBU-
LANCE SERVICES OR inpatient services which follow an emergency room
A. 7298 3
visit, for review to an independent dispute resolution entity upon
approval of the superintendent.
§ 4. Subsection (b) of section 606 of the financial services law, as
amended by section 7 of subpart A of part AA of chapter 57 of the laws
of 2022, is amended to read as follows:
(b) A non-participating provider shall not bill an insured for emer-
gency services, including AMBULANCE SERVICES OR inpatient services which
follow an emergency room visit, except for any applicable copayment,
coinsurance or deductible that would be owed if the insured utilized a
participating provider.
§ 4-a. Subsection (b) of section 606 of the financial services law, as
amended by section 14 of subpart A of part II of chapter 57 of the laws
of 2023, is amended to read as follows:
(b) A non-participating provider shall not bill an insured for emer-
gency services, including AMBULANCE SERVICES OR inpatient services which
follow an emergency room visit, or for services rendered by a mobile
crisis intervention services provider licensed, certified, or designated
by the office of mental health or the office of addiction services and
supports, except for any applicable copayment, coinsurance or deductible
that would be owed if the insured utilized a participating provider.
§ 5. This act shall take effect immediately and shall apply to poli-
cies and contracts issued, renewed, amended, modified or altered on or
after such date; provided however, that section two-a of this act shall
take effect on the same date and in the same manner as section 13 of
subpart A of part II of chapter 57 of the laws of 2023, takes effect;
and provided further however, that section four-a shall take effect on
the same date and in the same manner as section 14 of subpart A of part
II of chapter 57 of the laws of 2023, takes effect.