New York State Legislative Bill Mandating Direct Payment To Out Of Network Clinical Laboratory Providers

  • Jan 7 2013

The New York State Senate and Assembly have introduced a bill (S.1083/A.636) to amend the Public Health Law (Section 4406) and the Insurance Law (Section 4084), in relation to reimbursement of out-of-network clinical laboratory providers by a commercial health benefit plan.

The bill would require commercial health benefit plans to make payment for laboratory services directly to the out-of-network provider and deem any payment to the enrollee as insufficient to satisfy the payment obligation.

An interesting provision within the proposed mandate is that the enrollee remains responsible for any applicable copayment, deductible or coinsurance. However, the provision does not expressly condition the direct payment upon the clinical laboratory’s collection of the copayment, deductible or coinsurance from the enrollee.

The bill will be referred on January 9, 2013 to the Senate Committee on Health and the Assembly Committee on Insurance.

This post is contributed by Charles Dunham.

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