NY S07745

Requires insurers and health plans to maintain adequate provider networks meeting health care needs with appropriate choices, subject to superintendent review at approval, every three years, and upon service area expansion.

Mandates insurers offer at least one policy option providing 80% coverage of usual and customary out-of-network costs after deductible, with clear disclosure of reimbursement methodology and anticipated out-of-pocket costs.

Establishes "usual and customary cost" as the 80th percentile of charges for specific health care services in the same specialty and geographical area using an independent nonprofit benchmarking database.

Allows patients to appeal denials of out-of-network referrals by submitting written statements from their attending physician documenting inadequate in-network provider training and recommending qualified out-of-network providers.

Prohibits physicians from charging excessive fees for emergency services; creates independent dispute resolution process to review disputed charges exceeding usual and customary costs, with determinations binding on all parties.

Requires health care professionals to disclose participating health plans and hospital affiliations, provide claim forms with patient bills, and notify patients of out-of-network providers' anticipated costs and services.