Relates to reimbursement for ambulance services; requires insurers to submit payments directly to ambulance providers who are in-network or, for out-of-network ambulance providers, requires the issuance of a joint check to the insured specifying both the insured and the ambulance provider as payees.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A3496
SPONSOR: Pretlow
 
TITLE OF BILL:
An act to amend the insurance law, in relation to reimbursement for
ambulance services
 
PURPOSE:
To require insurers to submit payments directly to ambulance providers
who are in-network or, for out-of-network ambulance providers, to
require the issuance of a joint check to the insured specifying both the
insured and the ambulance provider as payees.
 
SUMMARY OF PROVISIONS:
Amends sections 3216(i) (24), 3221 (1)(15) and 4303(aa) to require
insurers to submit payments directly to in-network ambulance providers
at the negotiated rates. For out-of-network ambulance providers where
there is no negotiated rate, the insurer is required to issue a joint
check to the insured specifying both the insured and ambulance provider
as payees, at the usual and customary charge. Further, the legislation
requires the insurer to issue reimbursement directly to the ambulance
provider if the insured has filed an assignment of benefits for such
ambulance services.
The legislation also requires the insurer to notify the ambulance
provider electronically upon the issuance of a joint check to the
insured. The notification must include the name of the patient, date of
service, date of payment, amount of payment and address to which the
payment was sent.
 
JUSTIFICATION:
This bill would amend the insurance law to require insurers to issue
joint signature checks to both the patient and ambulance service provid-
er when the patient utilizes an ambulance service provider that is a
non-participating provider of their network.
Currently, when a patient uses an out-of-network ambulance provider,
their insurance company will send the ambulance reimbursement payment
directly to the patient. The patient is then expected to forward that
reimbursement payment to the ambulance service that provided the
service. In many cases with a single signature check, the patients never
send the insurance reimbursement to the service provider. Rather, they
keep the money for themselves, diverting millions of dollars from our
healthcare system in the process.
This bill would insure that healthcare dollars stay in the healthcare
system and that healthcare providers are paid for the work that they do.
In order to cash the check, both parties would need to endorse the
check. Insurers would send the joint signature check to the patient, the
patient would sign it and send it to the ambulance provider. The ambu-
lance provider could then endorse the check and be paid for their
service. The insurer will also notify the ambulance provider when a
joint signature check has been sent to the patient.
Ambulance providers are mandated responders who must provider service
when an emergency call comes in. They answer these calls without know-
ledge of a patient's ability to pay and without concern of getting paid
at the time of service. But in order to keep the ambulance system strong
and viable they must collect payment for service. This bill would assist
in collecting payments.
 
LEGISLATIVE HISTORY:
2021-2022 referred to insurance
2019-2020 A3727 referred to insurance
2017-2018 A908 referred to insurance
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
3496
2023-2024 Regular Sessions
IN ASSEMBLY
February 3, 2023
___________
Introduced by M. of A. PRETLOW -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to reimbursement for
ambulance services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 24 of subsection (i) of section 3216 of the
2 insurance law is amended by adding a new subparagraph (F) to read as
3 follows:
4 (F) An insurer who issues reimbursement under this paragraph shall
5 submit such payments either directly to the provider at the rates nego-
6 tiated between the provider and the insurer, or if no rate has been
7 negotiated between the provider and insurer, then to the insured in the
8 form of a joint check specifying as payees both the insured and the
9 provider of ambulance services, at the usual and customary charge, which
10 shall not be excessive or unreasonable; provided however, if the provid-
11 er of ambulance services has on file a duly executed assignment of bene-
12 fits for such services to the insurer, notwithstanding any policy
13 language to the contrary, the issuer shall accept such assignment of
14 benefits and the insurer shall issue reimbursement solely to the provid-
15 er. An insurer issuing payment in the form of a joint check shall notify
16 the provider via electronic communication of the issuance of such
17 payment. The notification shall include the name of the patient, the
18 date of service, the date of payment, the amount of payment and the
19 address to which the payment was sent.
20 § 2. Paragraph 15 of subsection (1) of section 3221 of the insurance
21 law is amended by adding a new subparagraph (F) to read as follows:
22 (F) An insurer who issues reimbursement under this paragraph shall
23 submit such payments either directly to the provider at the rates nego-
24 tiated between the provider and the insurer, or if no rate has been
25 negotiated between the provider and insurer, then to the insured in the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05290-01-3
A. 3496 2
1 form of a joint check specifying as payees both the insured and the
2 provider of ambulance services, at the usual and customary charge, which
3 shall not be excessive or unreasonable; provided however, if the provid-
4 er of ambulance services has on file a duly executed assignment of bene-
5 fits for such services to the insurer, notwithstanding any policy
6 language to the contrary, the insurer shall accept such assignment of
7 benefits and the insurer shall issue reimbursement solely to the provid-
8 er. An insurer issuing payment in the form of a joint check shall notify
9 the provider via electronic communication of the issuance of such
10 payment. The notification shall include the name of the patient, the
11 date of service, the date of payment, the amount of payment and the
12 address to which the payment was sent.
13 § 3. Subsection (aa) of section 4303 of the insurance law is amended
14 by adding a new paragraph 6 to read as follows:
15 (6) An insurer who issues reimbursement under this subsection shall
16 submit such payments either directly to the provider at the rates nego-
17 tiated between the provider and the insurer, or if no rate has been
18 negotiated between the provider and insurer, then to the insured in the
19 form of a joint check specifying as payees both the insured and the
20 provider of ambulance services, at the usual and customary charge, which
21 shall not be excessive or unreasonable; provided however, if the provid-
22 er of ambulance services has on file a duly executed assignment of bene-
23 fits for such services to the insurer, notwithstanding any policy
24 language to the contrary, the insurer shall accept such assignment of
25 benefits and the insurer shall issue reimbursement solely to the provid-
26 er. An insurer issuing payment in the form of a joint check shall notify
27 the provider via electronic communication of the issuance of such
28 payment. The notification shall include the name of the patient, the
29 date of service, the date of payment, the amount of payment and the
30 address to which the payment was sent.
31 § 4. This act shall take effect immediately.