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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 State’s 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
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 insurer’s compliance with the external review law.

"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."

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 appeal; and
  • 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 www.ins.state.ny.us.

 

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