STATE OF NEW YORK
GEORGE E. PATAKI, GOVERNOR
December 12, 2001
GOVERNOR PATAKI: EXTERNAL REVIEW LAW WORKING FOR NEW YORKERS
NY Consumers Utilizing Rights Under Landmark Reform More Than Any Other State
Governor George E. Pataki today announced that New York State consumers are exercising their health insurance rights and winning access to critical care under the State's External Review Law. This landmark reform has been so successful that more New Yorkers are exercising their rights under this Law than consumers in any of the other 41 states with External Review Laws.
"Our External Review Law has empowered consumers and the results are clear--New Yorkers are utilizing this important tool to ensure that they receive insurance coverage for necessary medical treatments," Governor Pataki said. "The New York external appeal process is accessible to consumers, as evident by the volume of external appeal requests in New York--and it works."
Gregory V. Serio, Superintendent of the New York State Insurance Department, said, "As a critical component of the Governor's healthcare initiatives, the External Review Law gives consumers the right to obtain an independent review of a health plan's decision to deny coverage. I am pleased that New Yorkers are exercising their health insurance rights, and, as detailed in the most recent External Review Report, a large number of cases have provided access to treatment for consumers that would not otherwise have been made available."
The Annual Report provides a comprehensive overview of New York's External Appeal Program for its second year of operation and includes a description of external appeal results on a calendar year basis along with a summary of all external appeal results from the effective date of the program. There is also a comparison of results achieved by external appeal programs in other states.
Highlights from the report include:
- During the program's second year, there were over 1,600 requests for external appeals;
- Of all 41 states and the District of Columbia with external appeal programs currently in place, New York has received the highest number of external appeal requests;
- Since July 1999, 640 denials of coverage by health insurers have been overturned and an additional 150 denials were overturned in part; and
- 105 expedited external appeal decisions have been rendered with 50 overturned completely or in part. An appeal must be expedited if the patient's physician attests that a delay in treatment would pose an imminent threat to the patient's health. Expedited appeal decisions must be made by the agent within three days.
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 three 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.
The Insurance Department's external appeal hotline, 1-800-400-8882 assists 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 are also posted on the Insurance Department's Web site at www.ins.state.ny.us.