§ 608. Payment for independent dispute resolution entity. (a) For\ndisputes involving an insured, when the independent dispute resolution\nentity determines the health care plan's payment is reasonable, payment\nfor the dispute resolution process shall be the responsibility of the\nnon-participating provider. When the independent dispute resolution\nentity determines the non-participating provider's fee is reasonable,\npayment for the dispute resolution process shall be the responsibility\nof the health care plan. When a good faith negotiation directed by the\nindependent dispute resolution entity pursuant to paragraph four of\nsubsection (a) of section six hundred five of this article, or paragraph\nsix of subsection (a) of section six hundred seven of this article\nresults in a settlement between the health care plan and\nnon-participating provider, the health care plan and the\nnon-participating provider shall evenly divide and share the prorated\ncost for dispute resolution.\n (b) For disputes involving a patient that is not an insured, when the\nindependent dispute resolution entity determines the physician's fee is\nreasonable, payment for the dispute resolution process shall be the\nresponsibility of the patient unless payment for the dispute resolution\nprocess would pose a hardship to the patient. The superintendent shall\npromulgate a regulation to determine payment for the dispute resolution\nprocess in cases of hardship. When the independent dispute resolution\nentity determines the physician's fee is unreasonable, payment for the\ndispute resolution process shall be the responsibility of the physician.\n
‹ 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.