§ 605. Dispute resolution for emergency services. (a) Emergency\nservices for an insured. * (1) When a health care plan receives a bill\nfor emergency services from a non-participating provider, including a\nbill for inpatient services which follow an emergency room visit, the\nhealth care plan shall pay an amount that it determines is reasonable\nfor the emergency services, including inpatient services which follow an\nemergency room visit, rendered by the non-participating provider, in\naccordance with section three thousand two hundred twenty-four-a of the\ninsurance law, except for the insured's co-payment, coinsurance or\ndeductible, if any, and shall ensure that the insured shall incur no\ngreater out-of-pocket costs for the emergency services, including\ninpatient services which follow an emergency room visit, than the\ninsured would have incurred with a participating provider. The\nnon-participating provider may bill the health care plan for the\nservices rendered. Upon receipt of the bill, the health care plan shall\npay the non-participating provider the amount prescribed by this section\nand any subsequent amount determined to be owed to the provider in\nrelation to the emergency services provided, including inpatient\nservices which follow an emergency room visit.\n * NB Effective until after the superintendent of financial services\nand the commissioner of health have promulgated regulations\n * (1) When a health care plan receives a bill for emergency services\nfrom a non-participating provider, including a bill for inpatient\nservices which follow an emergency room visit, or a bill for services\nfrom a mobile crisis intervention services provider licensed, certified,\nor designated by the office of mental health or the office of addiction\nservices and supports, the health care plan shall pay an amount that it\ndetermines is reasonable for the emergency services, including inpatient\nservices which follow an emergency room visit or for the mobile crisis\nintervention services, rendered by the non-participating provider, in\naccordance with section three thousand two hundred twenty-four-a of the\ninsurance law, except for the insured's co-payment, coinsurance or\ndeductible, if any, and shall ensure that the insured shall incur no\ngreater out-of-pocket costs for the emergency services, including\ninpatient services which follow an emergency room visit or for the\nmobile crisis intervention services, than the insured would have\nincurred with a participating provider. The non-participating provider\nmay bill the health care plan for the services rendered. Upon receipt of\nthe bill, the health care plan shall pay the non-participating provider\nthe amount prescribed by this section and any subsequent amount\ndetermined to be owed to the provider in relation to the emergency\nservices provided, including inpatient services which follow an\nemergency room visit or for the mobile crisis intervention services.\n * NB Effective after the superintendent of financial services and the\ncommissioner of health have promulgated regulations\n * (2) A non-participating provider or a health care plan may submit a\ndispute regarding a fee or payment for emergency services, including\ninpatient services which follow an emergency room visit, for review to\nan independent dispute resolution entity.\n * NB Effective until after the superintendent of financial services\nand the commissioner of health have promulgated regulations\n * (2) A non-participating provider or a health care plan may submit a\ndispute regarding a fee or payment for emergency services, including\ninpatient services which follow an emergency room visit, or for services\nrendered by a mobile crisis intervention services provider licensed,\ncertified, or designated by the office of mental health or the office of\naddiction services and supports, for review to an independent dispute\nresolution entity.\n * NB Effective after the superintendent of financial s
‹ Prev All New York sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.