Authorizes payments to nonparticipating or nonpreferred providers of medical services

◆ The sponsor's argument

Why Gustavo Rivera says this is needed

Patients receiving medical care are frequently placed in the untenable position of being required to pay large upfront medical bills directly to nonparticipating or nonpreferred providers before the provider has even sought reimbursement from the patient's health insurer. In many cases, patients have already paid substantial insurance premiums for coverage and reasonably expect providers to first pursue payment through the patient's health plan. Current law does not adequately protect insured individuals from being pressured into paying the full cost of covered medical services upfront, even where an assignment of benefits has been executed and the insurer may ultimately be responsible for all or most of the cost of care. This practice creates unnecessary financial hardship, delays access to care, and can discourage patients from seeking medically necessary treatment. This legislation establishes a fair and transparent process by requiring providers who accept assignments of benefits to first submit claims to insurers and obtain claim determinations before billing patients beyond their applicable cost-sharing obligations. The bill also ensures that insurers make payments directly to providers when assignments of bene- fits are properly executed, thereby reducing confusion and disputes regarding reimbursement responsibility. By clarifying the obligations of both insurers and providers, this legislation strengthens consumer protections, promotes continuity of care, and helps prevent insured New Yorkers from being subjected to unnecessary upfront medical expenses for covered services.

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.