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This entry was published on 2022-04-22
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SECTION 608
Payment for independent dispute resolution entity
Financial Services Law (FIS) CHAPTER 18-A, ARTICLE 6
§ 608. Payment for independent dispute resolution entity. (a) For
disputes involving an insured, when the independent dispute resolution
entity determines the health care plan's payment is reasonable, payment
for the dispute resolution process shall be the responsibility of the
non-participating provider. When the independent dispute resolution
entity determines the non-participating provider's fee is reasonable,
payment for the dispute resolution process shall be the responsibility
of the health care plan. When a good faith negotiation directed by the
independent dispute resolution entity pursuant to paragraph four of
subsection (a) of section six hundred five of this article, or paragraph
six of subsection (a) of section six hundred seven of this article
results in a settlement between the health care plan and
non-participating provider, the health care plan and the
non-participating provider shall evenly divide and share the prorated
cost for dispute resolution.

(b) For disputes involving a patient that is not an insured, when the
independent dispute resolution entity determines the physician's fee is
reasonable, payment for the dispute resolution process shall be the
responsibility of the patient unless payment for the dispute resolution
process would pose a hardship to the patient. The superintendent shall
promulgate a regulation to determine payment for the dispute resolution
process in cases of hardship. When the independent dispute resolution
entity determines the physician's fee is unreasonable, payment for the
dispute resolution process shall be the responsibility of the physician.