Prohibits approved organizations providing coverage under the child health insurance plan from discriminating against health care providers which do not participate in the organization's health care network.
Impact
The implications of this bill are significant as it aims to expand the rights of health care providers to practice without the constraint of being tied to specific networks, which can often limit their capabilities to serve patients adequately. By preventing discrimination based on network participation, the bill could help mitigate the challenges faced by providers who do not align with certain organizations, ensuring that all qualified practitioners can offer their services to children under the insurance plan.
Summary
Bill A08004, introduced in the New York Assembly, seeks to amend the public health law by prohibiting approved organizations under the child health insurance plan from limiting the participation of certain health care providers based on their non-participation in the organization's health care network. The legislation emphasizes the importance of allowing a broader range of caregivers to provide necessary health services to children insured under this plan, thereby potentially increasing accessibility to care and enhancing treatment options for families.
Contention
Notable points of contention may arise from various stakeholders, particularly insurance organizations that benefit from restricting a provider's participation for network coherence and cost-efficiency purposes. These groups may argue that A08004 could lead to increased healthcare costs or inefficiencies within the system. However, proponents contend that enhancing provider diversity and access ultimately fosters better health outcomes for insured children, making the case that the bill addresses a crucial gap in child healthcare availability.
Same As
Prohibits approved organizations providing coverage under the child health insurance plan from discriminating against health care providers which do not participate in the organization's health care network.
Prohibits approved organizations providing coverage under the child health insurance plan from discriminating against health care providers which do not participate in the organization's health care network.
Requires an insurance company which owns a health care provider to pay any health care provider which it does not own an amount that is no less than the amount that it pays a health care provider which it does own for a comparable service; prohibits an insurance company which is owned by a health care provider from paying any health care provider which does not own such insurance company an amount that is less than the amount that it pays a health care provider which does own such company for a comparable service.
Requires an insurance company which owns a health care provider to pay any health care provider which it does not own an amount that is no less than the amount that it pays a health care provider which it does own for a comparable service; prohibits an insurance company which is owned by a health care provider from paying any health care provider which does not own such insurance company an amount that is less than the amount that it pays a health care provider which does own such company for a comparable service.
Enacts the "health insurance preauthorization disclosure act"; requires health insurance companies to provide participating health care providers with a list of health care treatments and services that require preauthorization from the health insurance company.
Prohibits hospitals, health systems, and health care providers from charging facility fees that are not covered by the patient's health insurance carrier.
Eliminates the prospective enrollment waiting period for children under the age of nineteen enrolling in the child health insurance plan program by enrolling a child retroactively to the first day of the month in which they are approved for coverage under such program.
Clarifies that the New York state health insurance program remains subject to certain provisions of the financial services law and coverage for usual and customary costs for out-of-network health care service.
Allows dental provider networks, certain health and hospital service corporations, and health care plans to enter into a third-party network contract to provide access to care services and discounted rates of a provider under a provider network contract.