Bill Text: NY S09077 | 2017-2018 | General Assembly | Introduced

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Bill Title: Relates to patient billing for emergency services received from an out of network health care provider.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2018-06-15 - REFERRED TO RULES [S09077 Detail]

Download: New_York-2017-S09077-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          9077
                    IN SENATE
                                      June 15, 2018
                                       ___________
        Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
          printed to be committed to the Committee on Rules
        AN ACT to amend the insurance law, in relation to  patient  billing  for
          emergency services
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Subsection (c) of section 3241 of  the  insurance  law,  as
     2  added  by  section  6  of  part  H of chapter 60 of the laws of 2014, is
     3  amended to read as follows:
     4    (c) (1) When an insured or enrollee under a contract  or  policy  that
     5  provides  coverage  for  emergency services receives the services from a
     6  health care provider that does not participate in the  provider  network
     7  of  an  insurer, a corporation organized pursuant to article forty-three
     8  of this chapter, a municipal cooperative health benefit  plan  certified
     9  pursuant  to  article  forty-seven of this chapter, a health maintenance
    10  organization certified pursuant to  article  forty-four  of  the  public
    11  health  law, or a student health plan established or maintained pursuant
    12  to section one thousand one hundred twenty-four of this chapter ("health
    13  care plan"), the health care plan shall: (A) ensure that the insured  or
    14  enrollee  shall  incur  no greater out-of-pocket costs for the emergency
    15  services than the insured or enrollee would have incurred with a  health
    16  care  provider  that  participates  in  the  health care plan's provider
    17  network; and (B) provide the insured or enrollee the option of assigning
    18  the payment of any benefits due under such contract or  policy  directly
    19  to  the  health  care provider. Whenever, in any health insurance claims
    20  form, an insured or enrollee  specifically  authorizes  the  payment  of
    21  benefits  directly  to  a health care provider, the health care provider
    22  shall submit claims for benefits to the  health care plan and the health
    23  care plan shall make payment for any benefits to the health care provid-
    24  er.
    25    (2) Whenever  an  insured  or  enrollee  specifically  authorizes  the
    26  payment  of benefits directly to a health care provider, the health care
    27  provider shall not   bill the insured or enrollee  for  payment  of  any
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD16065-02-8
        S. 9077                             2
     1  amount  other than any applicable  copayment, coinsurance and/or deduct-
     2  ible unless the health plan fails to honor an assignment of benefits.
     3    (3)  The  health  care  provider shall not further bill the insured or
     4  enrollee for any remaining balance once the health care  plan  has  made
     5  its initial payment for which the insured or enrollee must be held harm-
     6  less by the health plan, but shall, with notice to the insured or enrol-
     7  lee of the existing balance, resubmit the balance to the health plan. In
     8  the  event  an  insured  or enrollee mistakenly reimburses a health care
     9  provider for emergency services for which the insured  or  enrollee  has
    10  assigned   payment  of  benefits  pursuant  to  paragraph  one  of  this
    11  subsection, the health care provider shall promptly refund such payment,
    12  less any applicable copayment, coinsurance  and/or  deductible,  to  the
    13  insured or enrollee.
    14    For  the  purpose of this section, "emergency services" shall have the
    15  meaning set forth in subparagraph (D) of paragraph  nine  of  subsection
    16  (i)  of  section  three  thousand  two  hundred sixteen of this article,
    17  subparagraph (D) of paragraph four of subsection (k)  of  section  three
    18  thousand two hundred twenty-one of this article, and subparagraph (D) of
    19  paragraph  two  of subsection (a) of section four thousand three hundred
    20  three of this chapter.
    21    § 2. This act shall take effect on the ninetieth day  after  it  shall
    22  have become a law.