New York State
Insurance Department


ISSUED: 6/27/2001

FOR IMMEDIATE RELEASE

STATE APPROVES CERTIFICATION OF THIRD EXTERNAL REVIEW AGENT
Additional Agent Certified as 772 New Yorkers Win Cases and Receive Coverage

            Superintendent of Insurance Gregory V. Serio and Department of Health Commissioner Antonia C. Novello today announced the certification of New York State’s third external appeal agent, HAYES Plus, Incorporated. As a New York certified external appeal agent, HAYES Plus will be conducting external reviews for consumers denied coverage of medical treatments by health care plans.

            "The External Review Law has empowered New Yorkers who believe that they have been wrongly denied coverage for treatments. The success of the law is clear. External appeal agents have found in favor of consumers in 772 cases, demonstrating that the law is working to protect consumers," said Serio. "The responsibility of these agents is an important one and after careful consideration we are pleased to add this third external appeal agent in New York State."

            The external review law, a significant consumer protection measure initiated and approved by Governor Pataki, 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. External review requests are submitted to the Insurance Department, which screens requests for eligibility and completeness, and then assigns the request to a certified external review agent for an independent review by medical experts.

            As New York’s external review law is approaching its two year anniversary, the Insurance Department and the Health Department will soon be releasing their second annual report on the External Appeal Program.

            "In recent state comparison studies, it was revealed that New York has the highest volume of external appeals of all states, so we are pleased that HAYES Plus has been certified as an additional independent agent," added Serio.

            HAYES Plus, located in Lansdale, Pennsylvania is a national Independent Review Organization and has been performing external reviews in other states for several years. HAYES Plus joins Medical Care Management Corporation (MCMC) and Island Peer Review Organization (IPRO), who were certified when New York’s landmark external review law first became effective on July 1, 1999. The application for external appeal agent certification is available on the Insurance Department’s Web site at www.ins.state.ny.us and the Health Department’s Web site at www.health.state.ny.us, or may be obtained by calling the Insurance Department at (518) 474-4098 or the Health Department at (518) 486-6074.

            To assist New Yorkers in filing external appeal requests, consumers can contact the Insurance Department external appeal hotline 1-800-400-8882. In addition, 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 Web site at www.ins.state.ny.us.


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