S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  8091

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                               May 4, 2009
                               ___________

Introduced  by M. of A. EDDINGTON, PHEFFER, HYER-SPENCER, REILLY, ENGLE-
  BRIGHT, MAISEL, GABRYSZAK -- Multi-Sponsored by --  M.  of  A.  CLARK,
  KOON,  WEINSTEIN  -- read once and referred to the Committee on Insur-
  ance

AN ACT to amend the insurance law, in relation to requiring notification
  to insured persons that an out-of-network physician  may  be  used  in
  their procedure, test or surgery

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 3216 of the insurance law is amended  by  adding  a
new subsection (m) to read as follows:
  (M)  (1)  EVERY  PERSON  INSURED UNDER A POLICY OF ACCIDENT AND HEALTH
INSURANCE DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE  ENTI-
TLED  TO  NOTIFICATION  FROM  THE BILLING ENTITY PRIOR TO THE PROCEDURE,
TEST OR SURGERY, THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE  USED  IN  SUCH
PROCEDURE,  TEST  OR  SURGERY AND SUCH PHYSICIAN'S SERVICES SHALL NOT BE
COVERED BY THEIR INSURANCE POLICY.
  (2) THE PATIENT COSTS OF OUT-OF-NETWORK PHYSICIAN  SERVICES  SHALL  BE
COVERED  BY  THE  INSURANCE POLICY OF AN INSURED PERSON IF HE OR SHE HAS
NOT RECEIVED NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO  THE  HEALTH
SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
  S  2.  Section  3221  of  the insurance law is amended by adding a new
subsection (r) to read as follows:
  (R) (1) EVERY PERSON INSURED UNDER A POLICY  OF  ACCIDENT  AND  HEALTH
INSURANCE  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE SHALL BE ENTI-
TLED TO NOTIFICATION FROM THE BILLING ENTITY  PRIOR  TO  THE  PROCEDURE,
TEST  OR  SURGERY,  THAT AN OUT-OF-NETWORK PHYSICIAN MAY BE USED IN SUCH
PROCEDURE, TEST OR SURGERY AND SUCH PHYSICIAN'S SERVICES  SHALL  NOT  BE
COVERED BY THEIR INSURANCE POLICY.
  (2)  THE  PATIENT  COSTS OF OUT-OF-NETWORK PHYSICIAN SERVICES SHALL BE
COVERED BY THE INSURANCE POLICY OF AN INSURED PERSON IF HE  OR  SHE  HAS
NOT  RECEIVED  NOTIFICATION  OF  SUCH  SITUATIONS,  PRIOR  TO THE HEALTH
SERVICE OR PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
  S 3. This act shall take effect immediately.

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11140-01-9