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August 14, 2019

For Immediate Release:

HANYS’ advocacy helps consumers: New York takes steps to clarify insurance coverage, streamline processes

ALBANY, NY — The Healthcare Association of New York State supported a variety of bills this session aimed at making managed care work better for consumers. The New York State Legislature passed an array of new, HANYS-backed bills and rules that will streamline the patient experience and shield patients from the complexities of healthcare payment.

“Our patients need to focus on getting well. They should never be burdened with the insurance industry’s impossible rules, care delays and denials. HANYS and our members always put patients first and we’re proud of what we’ve accomplished in this regard,” said HANYS President Bea Grause.

For example, two bills that help consumers passed both houses of the New York State Legislature in June. HANYS worked with the legislature to gain passage of these bills and will encourage the governor to sign them into law:

  • The first bill (A.2880-B/S.5328-A) would ensure coverage for timely, needed services. It would prohibit an insurer from denying payment when the healthcare provider determines in the course of treatment that an additional related service or procedure is required. For example, if the provider receives approval from the insurer for a CT scan without contrast but during the procedure determines that the CT scan needs to be done with contrast to get a better image, the provider would not need to stop the procedure and seek authorization for the contrast.
  • The second bill (A.3059/S.1810) would decrease unnecessary and prolonged hospitalizations by requiring health plans to make a decision within 24 hours on a request for nursing home care when a patient needs to go from the hospital directly to a nursing home.

HANYS was also instrumental in pressing for several recent state actions that benefit consumers:

  • At HANYS’ urging, the Department of Health recently issued guidance to managed care plans that defines sepsis according to a standard that not only aligns with state and federal regulations, but that has also been proven to save lives.
  • The Department of Financial Services very recently proposed new regulations that would require health insurers to include key information on patient insurance identification cards, including the health plan product or plan name. Healthcare providers need this information up front because it enables them to give consumers more accurate information about the plan’s coverage.

HANYS commends the Department of Health and Department of Financial Services for these actions that improve the provision of care and the patient experience.

These recent governmental steps build upon HANYS’ previous efforts to help consumers get the care they need. HANYS played a leading role in securing these additional consumer-focused improvements:

  • allowing providers to file appeals for medically necessary services when an insurer refuses to pay for a service, ensuring that the consumer is insulated from the process;
  • gaining passage of the state’s surprise billing law that protects consumers from unexpected bills for services provided by out-of-network providers;
  • requiring insurers to cover tomosynthesis, a life-saving 3D mammography imaging technique that screens for early signs of breast cancer in women with no symptoms; and
  • preventing insurers from forcing consumers to fill out complex questionnaires about coverage, subsequent to treatment, before approving coverage for emergency services.

The Healthcare Association of New York State is the only statewide hospital and continuing care association in New York, representing nonprofit and public hospitals, nursing homes, home care agencies and other healthcare organizations.