Bill Text: NY A01129 | 2017-2018 | General Assembly | Introduced

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Bill Title: Limits denial of coverage of additional treatment related to health care services for which pre-authorization is required and was granted.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2018-01-22 - REFERRED TO INSURANCE [A01129 Detail]

Download: New_York-2017-A01129-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          1129
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                    January 10, 2017
                                       ___________
        Introduced by M. of A. HUNTER -- read once and referred to the Committee
          on Insurance
        AN  ACT to amend the insurance law, in relation to denial of coverage of
          treatment related to health care services for which  pre-authorization
          was granted
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Section 3238 of the insurance law is amended  by  adding  a
     2  new subsection (c-1) to read as follows:
     3    (c-1)  If a health plan denies payment for the treatment of concurrent
     4  symptoms or side effects due  to  lack  of  pre-authorization  and  such
     5  treatment  is  rendered  at  the  same time as a health care service for
     6  which pre-authorization was required and received, upon  the  appeal  of
     7  the denial, the denial of any such service shall be upheld only if it is
     8  determined that:
     9    (1) the treatment is not a covered benefit;
    10    (2) the treatment was not medically necessary pursuant to section four
    11  thousand nine hundred four of this chapter or section forty-nine hundred
    12  four of the public health law;
    13    (3)  the  treatment  was  experimental  or investigational pursuant to
    14  section four thousand nine hundred  four  of  this  chapter  or  section
    15  forty-nine hundred four of the public health law; or
    16    (4)  one  of the conditions set forth in paragraphs one through six of
    17  subsection (a) of this section is met.
    18    § 2. This act shall take effect on the ninetieth day  after  it  shall
    19  have become a law.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02613-01-7