NY State Senate Bill 2025-S4012

Senate Bill S4012

2025-2026 Legislative Session

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery

download bill text pdf

Current Bill Status - In Senate Committee Insurance 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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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 31, 2025	referred to insurance

2025-S4012 (ACTIVE) - Details

See Assembly Version of this Bill:: A3488
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216 & 3221, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S7186, A9773, A8091
2011-2012: S1119, A495
2013-2014: S2637, A635
2015-2016: S1513, A7235
2017-2018: S3118, A2792
2019-2020: S4502, A2765
2021-2022: S4787, A1983
2023-2024: S5753, A2663

2025-S4012 (ACTIVE) - Summary

Requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery and such physician's services shall not be covered by their insurance policy; provides such services must be covered if the insured person does not receive notification prior to such services or procedure.

2025-S4012 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S4012

SPONSOR: PARKER
 
TITLE OF BILL:

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

 
PURPOSE OR GENERAL IDEA OF BILL:

To provide notice to patients that services provided may not be covered
by health insurance.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1: Section 3216 of the insurance law is amended by adding a new
subsection (n).

Section 2: Section 3221 of the insurance law is amended by adding a new
subsection (u).

Section 3: This act shall take effect immediately.

 
JUSTIFICATION:

Very often out of network providers perform services to patients without
Patients being made aware that they will be responsible for payment for
such services as the provider is not a participating physician of the
patient's insurance carrier. An example would be an anesthesiologist who
meets a patient shortly before surgery. If the anesthesiologist is not a
participating provider, the patient will receive a bill and be responsi-
ble for payment. Had the anesthesiologist been a participating provider,
the Patient would only be responsible for a co-payment. If a patient is
informed who the provider will be before services are rendered they have
the opportunity to arrange for a different provider, one which partic-
ipates with their insurance plan.

 
PRIOR LEGISLATIVE HISTORY:

2023-24: S5753 -Referred to Insurance

2021-22: S4787 - Referred to Insurance

2019-20: S.4502/A2765 - Referred to Insurance

2017-18: S.3118/ A2792 - REFERRED TO INSURANCE

2015-16: S.1513/A.7235 - Referred to Insurance

2013-14: S.2637A - Referred to Insurance

2011-12: S.1119/AA95 - Referred to Insurance

2009-10: S.7186/A.9773 - Referred to Insurance

2007-08: A.101243

 
FISCAL IMPLICATIONS:
None.

 
EFFECTIVE DATE:
This act shall take effect Immediately.

2025-S4012 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4012
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 31, 2025
                                ___________
 
 Introduced  by  Sen.  PARKER -- 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 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 (n) to read as follows:
   (N)  (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 THEY HAVE NOT
 RECEIVED NOTIFICATION OF SUCH SITUATIONS, PRIOR TO THE HEALTH SERVICE OR
 PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
   § 2. Section 3221 of the insurance law is  amended  by  adding  a  new
 subsection (v) to read as follows:
   (V)  (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 THEY HAVE NOT
 RECEIVED NOTIFICATION OF SUCH SITUATIONS, PRIOR TO THE HEALTH SERVICE OR
 PROCEDURE, AS PRESCRIBED IN PARAGRAPH ONE OF THIS SUBSECTION.
   § 3. This act shall take effect immediately.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD07470-01-5

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