BILL NUMBER:  S6491

 TITLE OF BILL :  An act to amend the insurance law, in relation to
requiring health insurers to provide insureds and covered persons the
option to assign the payment of emergency services benefits directly
to an out of network health care provider

 PURPOSE: :

To ensure payment is made directly to the out-of-network emergency
health care provider when the covered individual has assigned benefits
for the services rendered.

 SUMMARY OF PROVISIONS: :

This act will amend subsection (c) of section 3241 of the Insurance
Law to add a new requirement that an insurer that provides benefits to
a subscriber under a contract or policy that provides for emergency
services provide the subscriber the option of assigning the payment of
any benefits to out-of-network health care providers and that the
insurer shall make such payment directly to the out-of-network
healthcare provider.

Section three provides that this act shall take effect 90 days after
enactment.

              

 JUSTIFICATION: :

Either before or after accessing health care services, most consumers
sign written consent forms authorizing providers to bill their
insurance companies for the services they provide and assigning any
payment due for those services directly to the provider. This relieves
consumers of the burden of filing claims, chasing reimbursement and
remitting payment to providers which can be a complex process and
particularly difficult when the consumer is unwell and undergoing
treatment. However, some insurers prohibit consumers from assigning
benefits for services they receive from providers that do not
participate in the insurer's network. This is a particular problem
when consumers receive emergency services from out-of-network
providers. In emergency situations consumers are not always able to
access in-network providers and hospitals must treat all patients in
need of emergency care regardless of whether they participate in the
consumer's insurance plan. In these situations, if the insurer does
not permit the patient to assign their insurance benefits, the patient
is put in the middle between the insurer and the provider.

With insurers increasingly narrowing provider networks, it is becoming
more common for hospitals to be out-of-network with some insurers.
There have been recent instances of a major insurer issuing all
out-of-network emergency payments to the patient or subscriber, even
where the subscriber has signed an assignment of benefits. This has
confused and upset patients as providers have been forced to bill them
for services in order to get paid. It has also increased
administrative work for hospitals and negatively impacted cash flow.
This legislation would amend the Insurance Law to require insurers to
give subscribers the option to assign benefits for out-of-network
emergency services to the provider and to ensure that when benefits
have been assigned, payment is issued directly to the provider.

 LEGISLATIVE HISTORY: :

New bill.

 FISCAL IMPLICATIONS: :

None.
 EFFECTIVE DATE: :

90 days after enactment.