NY A08909

Health plans must pay out-of-network clinical laboratory providers directly when an enrollee is referred by an in-plan provider, rather than reimbursing the enrollee.

Payment to out-of-network clinical laboratories must be made according to the timeframe specified in Insurance Law section 3224-a.

Enrollees remain responsible for applicable copays, coinsurance, and deductibles for out-of-network clinical laboratory services.

Clinical laboratories must bill the health plan organization directly for reimbursement, and payments made to enrollees do not satisfy the plan's payment obligation to the laboratory.

The amendments apply to both Public Health Law section 4406 and Insurance Law section 4804, and take effect immediately.