Senate Bill S7159

2019-2020 Legislative Session

Requires specification between partial approval of medical claims and full denial of medical claims on written notices to an insurer

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Assembly Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2019-S7159 (ACTIVE) - Details

See Assembly Version of this Bill:
A9085
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §3224-a, Ins L
Versions Introduced in 2021-2022 Legislative Session:
S2008, A1677

2019-S7159 (ACTIVE) - Summary

Requires specification between partial approval of medical claims or payments and full denial of medical claims or payments on written notices to an insurer or an organization or corporation licensed or certified.

2019-S7159 (ACTIVE) - Sponsor Memo

2019-S7159 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7159
 
                             I N  S E N A T E
 
                              January 9, 2020
                                ___________
 
 Introduced  by Sens. JACKSON, BENJAMIN, CARLUCCI, RAMOS, SALAZAR -- read
   twice and ordered printed, and when printed to  be  committed  to  the
   Committee on Insurance
 
 AN  ACT  to amend the insurance law, in relation to requiring specifica-
   tion between partial approval  of  medical  claims  and  a  denial  of
   medical claims on written notices to an insurer

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (b) of section 3224-a of the insurance  law,  as
 amended  by  chapter  237  of  the  laws  of 2009, is amended to read as
 follows:
   (b) In a case where the obligation of an insurer or an organization or
 corporation licensed or certified pursuant  to  article  forty-three  or
 forty-seven  of  this chapter or article forty-four of the public health
 law to pay a claim or make a payment for health care  services  rendered
 is not reasonably clear due to a good faith dispute regarding the eligi-
 bility  of  a  person  for coverage, the liability of another insurer or
 corporation or organization for all or part of the claim, the amount  of
 the  claim,  the  benefits covered under a contract or agreement, or the
 manner in which services were accessed or provided, an insurer or organ-
 ization or corporation shall pay any undisputed portion of the claim  in
 accordance  with  this  subsection  and notify the policyholder, covered
 person or health care provider in writing within thirty calendar days of
 the receipt of the claim:
   (1) WHETHER THE CLAIM OR BILL HAS BEEN DENIED OR PARTIALLY APPROVED;
   (2) WHICH CLAIM OR MEDICAL PAYMENT that it is  not  obligated  to  pay
 [the  claim  or  make the medical payment,] stating the specific reasons
 why it is not liable; [or
   (2)] AND
   (3) to request all additional information needed to determine  liabil-
 ity to pay the claim or make the health care payment.
   Upon  receipt of the information requested in paragraph [two] THREE of
 this subsection or an appeal of a claim or bill for health care services
 denied pursuant to [paragraph one of] this  subsection,  an  insurer  or
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

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