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A03496 Summary:

BILL NOA03496
 
SAME ASSAME AS S01465
 
SPONSORPretlow
 
COSPNSR
 
MLTSPNSR
 
Amd §§3216, 3221 & 4303, Ins L
 
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.
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A03496 Actions:

BILL NOA03496
 
02/03/2023referred to insurance
01/03/2024referred to insurance
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A03496 Memo:

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.
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A03496 Text:



 
                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.
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