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The Office of General Counsel issued the following informal opinion on January 9, 2002, representing the position of the New York State Insurance Department.

RE: Prompt Pay

Question Presented:

What constitutes payment pursuant to N.Y. Ins. Law § 3224-a (McKinney 2000)?

Conclusion:

N.Y. Ins. Law § 3224-a (McKinney 2000) requires payment of health claims by health insurance companies within 45 days of receipt of such claim. In this context, "payment" is made when the insurer has fulfilled its statutory obligation of executing payment by issuing a check, and placing such check in the mail, or personally delivering it.

Facts:

No specific fact pattern was provided.

Analysis:

The relevant statute is N.Y. Ins. Law § 3224-a (McKinney 2000), which states, in the relevant part:

In the processing of all health care claims submitted under contracts or agreements . . .

(a) . . . such insurer or organization or corporation shall pay the claim to a policyholder or covered person or make a payment to a health care provider within forty-five days of receipt of a claim or bill for services rendered.

In this context, "payment" is made when the insurer has fulfilled its statutory obligation of executing payment by issuing a check, and placing such check in the mail, or personally delivering it.

For further information you may contact Senior Attorney Susan A. Dess at the New York City Office.

 

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