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STATE OF NEW YORK
INSURANCE DEPARTMENT
25 BEAVER STREET
NEW YORK, NEW YORK 10004

The Office of General Counsel issued the following informal opinion on May 8, 2000 representing the position of the Department.

Re: No-Fault Payments for Medical Transportation Services

Question Presented:

May a transportation company that has entered into a medical transportation agreement with another transportation company ("the sub-contractor") to provide medical transportation services covered by no-fault insurance bill the no-fault insurer for such a service when performed by the sub-contractor under such an agreement for a no-fault claimant?

Conclusion:

Yes, if the bill is for ambulance services, a transportation company that has entered into a subcontracting agreement with another transportation company to provide services to no-fault claimants may, if it has obtained a valid assignment of benefits from the no-fault claimant and if the sub-contractor is properly registered or certified to provide such services (or is exempted from such requirements), bill the no-fault insurer for such a service that has been performed by the sub-contractor for the no-fault claimant. No, if the bill is for other reasonable and necessary expenses. While the no-fault claimant has the right to be reimbursed for such expenses, he or she cannot assign such right to reimbursement to a person who has not performed health services.

Facts:

A transportation company proposes entering into an agreement with another transportation company to provide "medical transportation" services, the cost of which are presumed to be covered under no-fault. Under the proposed agreement, one company is going to be providing the transportation services under a subcontract to the other. The entity subcontracting out the services will do the billing and will in turn pay the provider actually performing the services.

Analysis:

The term "medical transportation," is not defined in either Article 51 of the New York Insurance Law (McKinney 1985 and Supp. 2000) or Department Regulation No. 68 (N.Y. Comp. Codes R. & Regs. tit. 11 § 65 (1999), the provisions which implement the No-fault Law in New York. For purposes of this inquiry, it is assumed that the services being performed are covered expenses under no-fault insurance coverage. However, in terms of rights to reimbursement under basic economic loss, the response to this inquiry will differ depending upon the specific type of services performed.

If what is being provided constitutes an ambulance service, then the charges therefor are an element of "basic economic loss" under § 5102(a)(1) of the Insurance Law (McKinney's Supp. 1999-2000). While there is no restriction in the aforementioned no-fault regulation against effectuating an assignment of benefits for health related ambulance services, ambulance services are regulated in New York State and some ambulance service providers must have an operating certificate or registration. Under the Public Health Law § 3005(1) (McKinney 1993) for profit, hospital ambulance services and municipal ambulance services of a city with a population of over one million must possess an ambulance service operating certificate or registration. Certain voluntary ambulance services are exempt from such requirements under Public Health Law § 3003(5-a). If the no-fault insurer will be billed for an ambulance service, and applicable law requires that the sub-contractor transportation company performing those services under the agreement must have a certificate or registration in order to operate, the subcontractor could not bill the no-fault insurer for those ambulance services if it is not so certified or registered.

On the other hand, if the transportation services in question constitute an element of basic economic loss under § 5102(a)(3) for reasonable and necessary expenses incurred, up to twenty-five dollars per day, then only the eligible injured person (the no-fault claimant) can receive reimbursement for these expenses. See, N.Y. Comp. Codes R. & Regs. tit. 11 § 65-3.11(a). Under the foregoing portion of the no-fault regulation, the right of the no-fault claimant to be reimbursed for such expenses cannot be assigned.

For further information contact Associate Attorney Barbara Kluger at the Department’s New York Office.