Legislation

§ 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.

* NB Effective until August 26, 2026

* (b) (1) A non-participating provider and a health care plan shall
submit full payment for the dispute resolution process upon submission
of the dispute resolution application or, if the responding party, when
responding to the independent dispute resolution entity's request for
eligibility information and supporting documents.

(2) An independent dispute resolution entity shall not comingle the
payments for the dispute resolution process with any other funds held by
the entity and shall hold all payments in a separate account.

(3) An independent dispute resolution entity shall issue a refund of
the dispute resolution process payment to the prevailing party within
thirty days of rendering a determination on the dispute or rejecting the
dispute as ineligible.

* NB Effective August 26, 2026

* (c) 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.

* NB Effective August 26, 2026