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NY A07292
Bill
Status
3/25/2025
Primary Sponsor
Gary Pretlow
Click for details
AI Summary
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Requires health maintenance organizations (HMOs) in New York to provide additional information when denying claims based on medical necessity determinations
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When denying coverage, HMOs must either inform the insured of preferred procedures or treatments that would be covered, or provide a statement explaining the past ineffectiveness of the requested procedure or treatment
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Adds new section 2601-a to the insurance law governing denial of coverage communications
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Takes effect 30 days after becoming law
Legislative Description
Directs a health maintenance organization which denies a claim due to absence of medical necessity to inform the insured as to preferred alternative treatment, or provide the insured with a statement as to the past ineffectiveness of the requested procedure or treatment.
Last Action
referred to insurance
1/7/2026