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This entry was published on 2020-01-10
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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 physician or hospital. When the independent dispute
resolution entity determines the non-participating physician's or
hospital'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 physician or hospital, the health care
plan and the non-participating physician or hospital 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.