Provides for network participation verification and disclosure

◆ The sponsor's argument

Why Robert Jackson says this is needed

Patients in New York State frequently rely on representations made by health care providers regarding whether a provider participates in their health insurance network. However, in many cases, these representations are based on inaccurate, outdated, or incomplete information rather than real-time verification. As a result, patients often discover only after receiving services that a provider was out-of-network, leading to significantly higher out-of-pocket costs and unexpected medical bills. Current federal and state law addresses emergency services and certain facility-based providers, but it does not require providers to verify and document network participation before scheduling non-emergency services. This bill closes that gap by establishing clear standards for network participation verification and disclosure. It requires health care providers to obtain real-time confirmation of their network partic- ipation status from the patient's insurer before representing themselves as in-network. By creating a standardized verification process and strengthening disclosure requirements, this bill protects patients from avoidable out-of-network charges and ensures that patients receive consistent and accurate information regarding the potential cost implications of their care before services are provided.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.