New York State
Insurance Department


ISSUED: 7/21/2000

FOR IMMEDIATE RELEASE

 
GOVERNOR PATAKI: FIRST YEAR OF HMO EXTERNAL REVIEW LAW A SUCCESS

331 New York Consumers Win Cases and Receive Coverage Under Landmark Reform

            Governor George E. Pataki today announced that New York State consumers are exercising their health insurance rights and winning cases under the State’s one-year old External Review Law.

            "Our External Appeal Law is empowering consumers to protect themselves when denied coverage for medical treatments and I am delighted to see it working for New York’s families," Governor Pataki said.

            New York’s landmark External Review Law became effective July 1, 1999. The law gives consumers the right to obtain an independent review of a health plan’s decision to deny coverage on the grounds that the service was not medically necessary or is experimental or investigational. To date, external appeal agents have found in favor of consumers in 331 cases, demonstrating that the law is protecting consumers.

            Neil D. Levin, Superintendent of the New York State Insurance Department, said, "The External Appeals Law established a prompt, consistent and fair process with treatment decisions being made because they are smart medical choices and not simply sound financial decisions. Our priority as insurance regulators is to protect consumers in New York State and after one year it is evident that the External Appeals Law is working to accomplish this goal."

            External appeal requests are submitted to the Insurance Department, which screens requests for eligibility and completeness and assigns the appeal to one of the state’s two certified external review agents. The Insurance Department and the Department of Health have participated in informational seminars throughout the state on the external review process.

            In addition, the Insurance Department launched an external appeal hotline, 1-800-400-8882, to assist New Yorkers in filing external appeal requests. The Insurance Department has staff on-call seven days a week to handle expedited appeals. External appeal applications and information is also posted on the Insurance Department’s website at www.ins.state.ny.us.

            The Insurance Department and the Health Department will soon be releasing an annual report that will include a comprehensive analysis of the results from the first year of operations of the external appeal program. 


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