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The Office of General Counsel issued the following opinion on July 1, 2005, representing the position of the New York State Insurance Department.

Re: No-Fault: Preferred Providers Organization (PPO)

Question Presented:

Can a No-Fault insurer contract with a preferred provider organization ("PPO") with respect to health services rendered to eligible injured persons?

Conclusion:

Yes, provided that the eligible injured person covered by the No-Fault insurer is free to choose health providers who are not affiliated with the PPO when seeking medical treatment.

Facts:

None presented.

Analysis:

There is nothing in the Insurance Law that prohibits an insurer from affiliating with a network of health care providers that may be utilized, on a voluntary basis, by eligible injured persons covered under No-Fault. An eligible injured person may choose to seek treatment from a health provider employed by the affiliated PPO when seeking health services as a result of injuries sustained in an automobile accident. However, the No-Fault insurer may not induce or require an eligible injured person to be treated by any of the health providers employed by the PPO.

No official approval is necessary for a PPO to affiliate with a No-Fault insurer to provide health related services to those injured individuals who voluntarily choose treatment from a PPO provider. This, however, does not relieve the PPO from any licensing, authorization and/or approval processes required under New York law.

For further information you may contact Supervising Attorney Lawrence M. Fuchsberg at the New York City Office.

 

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