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This entry was published on 2014-09-22
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SECTION 3231*2
Health insurance policies and subscriber contracts; prohibited claims
Insurance (ISC) CHAPTER 28, ARTICLE 32
* § 3231. Health insurance policies and subscriber contracts;
prohibited claims. (a) For the purposes of this section the terms health
care provider, practitioner, clinical laboratory services, pharmacy
services, radiation therapy services, physical therapy services or x-ray
or imaging services shall have the same meanings as are set forth in
section two hundred thirty-eight of the public health law.

(b) No health care provider or practitioner may demand or request any
payment for clinical laboratory services, pharmacy services, radiation
therapy services, physical therapy services or x-ray or imaging services
furnished pursuant to a referral prohibited by subdivision one of
section two hundred thirty-eight-a of the public health law.

(c) No insurer shall be required to pay any claim, bill or other
demand or request for payment by a health care provider for clinical
laboratory services, pharmacy services, radiation therapy services,
physical therapy services or x-ray or imaging services furnished
pursuant to a referral prohibited by subdivision one of section two
hundred thirty-eight-a of the public health law.

(d) Every policy of accident or health insurance issued by a
commercial insurer and every subscriber contract issued by a hospital
service corporation, health service corporation or medical expense
indemnity corporation which provides coverage for clinical laboratory
services, pharmacy services, radiation therapy services, physical
therapy services or x-ray or imaging services shall include a provision
excluding payment of any claim, bill or other demand or request for
payment for such services furnished pursuant to a referral prohibited by
subdivision one of section two hundred thirty-eight-a of the public
health law.

(e) Every insurer subject to the provisions of this section shall
report to the commissioner of health any pattern of submission of
claims, bills or other demands or requests for payment submitted in
violation of subsection (b) of this section, within thirty days after
such insurer has knowledge of such pattern.

(f) Notwithstanding the requirements of subsections (c), (d) and (e)
of this section, an insurer reimbursing for clinical laboratory
services, pharmacy services, radiation therapy services, physical
therapy services or x-ray or imaging services is not required to audit
or investigate any claim, bill or other demand or request for payment
for such items or services furnished pursuant to a referral.

* NB There are 2 § 3231's