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S. 4481-A(Seward)/A. 11737(Morelle)

Consumer Protection

Summary: The bill enhances consumer and provider protections by:

1. requiring insurers to extend protections regarding referrals to specialists and grievance procedures;

2. removing the limitation that a member's contract must be in effect as of the date a dividend or credit is issued in the event a loss ratio requirement is not met;

3. offering protections to providers against an adverse reimbursement change to a contract;

4. permitting newly licensed physicians and physicians moving to New York to be provisionally credentialed until the final credentialing determination is made by the insurer or health care plan; and

5. extending to providers the right to pursue an external appeal of a concurrent adverse determination.

Specifics include:

Effective Date: N/A.

Last Action: The bill passed the Senate and was referred to the Assembly on June 24, 2008.

Department of Financial Services

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