New York State
INSURANCE DEPARTMENT ANNOUNCES EXTERNAL
REVIEW HOTLINE FOR CONSUMERS
New York, June 10, 1999
Superintendent of Insurance Neil D. Levin today announced that the
Insurance Department has launched a new toll-free hotline to answer consumer questions
about New York States new External Review Law. The toll-free number is 1-800-400-8882.
The toll-free hotline gives consumers information about the landmark
law, which will be effective
"Consumers in New York State now have more power in
determining their medical treatments," said Levin. "We want consumers to be well
aware of their new health insurance right. This new hotline will provide information about
the new law and will also allow us to act on consumer complaints promptly."
July 1. The hotline will provide consumers with information about their rights if their
medical claims have been unfairly denied for reasons of medical necessity or because of
experimental procedures. Consumers can also lodge their complaints on the hotline about
their insurers compliance with the external review law.
Governor Pataki signed the bill into law in August 1998 to protect
consumers wrongly denied coverage for medical treatments by health care insurers on the
grounds that the service is not medically necessary or experimental.
Highlights of the law include:
- Establishing a prompt, consistent and fair external review process for all covered
health care services denied on the grounds that the service is not medically necessary;
- Establishing an external review process for patients with life-threatening or disabling
conditions seeking clinical trials, off-label use of drugs and experimental or
investigational procedures or treatments when such services are denied upon the basis that
they are experimental;
- Establishing guidelines and time limits for companies to evaluate internal appeals; and
- Requiring insurers to give written notice to patients of their right to an external
- Requiring the external agent to make a determination on an appeal within 30-days or
three days for emergency cases;
- Directing that requests for external reviews can be made after the health care plan has
rendered a final adverse coverage determination. The final adverse determination results
when the plan has either disapproved the request for coverage made through the expedited
appeal or through the standard internal appeal of the initial coverage denial.
In addition to the new hotline telephone number, consumers can obtain
information about the External Review Law from the Department website at