2006 New York Code - Prohibitions.

 
    §  3217-b.  Prohibitions. (a) No insurer subject to this article shall
  by contract, written policy or written procedure  prohibit  or  restrict
  any  health  care  provider  from  disclosing to any insured, designated
  representative or, where appropriate, prospective insured,  (hereinafter
  collectively  referred to as insured) any information that such provider
  deems appropriate regarding:
    (1) a condition or a course of treatment with an insured including the
  availability of other therapies, consultations, or tests; or
    (2) the provisions, terms, or requirements of the  insurer's  products
  as they relate to the insured.
    (b)  No  insurer  subject  to  this article shall by contract, written
  policy or  written  procedure  prohibit  or  restrict  any  health  care
  provider  from  filing  a complaint, making a report or commenting to an
  appropriate governmental body regarding the  policies  or  practices  of
  such  insurer which the provider believes may negatively impact upon the
  quality of, or access to, patient care.
    (c) No insurer subject to this  article  shall  by  contract,  written
  policy  or  written  procedure  prohibit  or  restrict  any  health care
  provider from advocating to the insurer on behalf  of  the  insured  for
  approval  or  coverage  of  a  particular course of treatment or for the
  provision of health care services.
    (d) No contract or  agreement  between  an  insurer  subject  to  this
  article  and  a health care provider shall contain any clause purporting
  to transfer to the health care provider by indemnification or  otherwise
  any  liability  relating  to  activities,  actions  or  omissions of the
  insurer as opposed to the health care provider.
    (e) Contracts entered into  between  an  insurer  and  a  health  care
  provider shall include terms which prescribe:
    (1)  the  method  by  which  payments  to  a  provider,  including any
  prospective or retrospective adjustments thereto, shall be calculated;
    (2) the time periods within which such calculations will be completed,
  the dates  upon  which  any  such  payments  and  adjustments  shall  be
  determined  to  be  due,  and the dates upon which any such payments and
  adjustments will be made;
    (3) a description  of  the  records  or  information  relied  upon  to
  calculate  any  such  payments and adjustments, and a description of how
  the provider can access a summary of such calculations and adjustments;
    (4) the process to  be  employed  to  resolve  disputed  incorrect  or
  incomplete  records  or  information and to adjust any such payments and
  adjustments which have been calculated by relying on any such  incorrect
  or  incomplete  records  or  information so disputed; provided, however,
  that nothing  herein  shall  be  deemed  to  authorize  or  require  the
  disclosure of personally identifiable patient information or information
  related  to  other  individual  health  care  providers  or  the  plan's
  proprietary data collection systems, software or  quality  assurance  or
  utilization review methodologies; and
    (5)  the right of either party to the contract to seek resolution of a
  dispute arising pursuant to the payment terms of such contracts  through
  a  proceeding  under  article seventy-five of the civil practice law and
  rules.
    (f) No contract entered into between an  insurer  and  a  health  care
  provider  shall  be  enforceable  if  it  includes  terms which transfer
  financial  risk  to  providers,  in  a  manner  inconsistent  with   the
  provisions  of  paragraph  (c)  of subdivision one of section forty-four
  hundred three of the  public  health  law,  or  penalize  providers  for
  unfavorable  case  mix  so  as to jeopardize the quality of or insureds'
  appropriate access to medically necessary services;  provided,  however,
  that payment at less than prevailing fee for service rates or capitation
  shall  not  be  deemed  or presumed prima facie to jeopardize quality or
  access.
    (g)  Any  contract  provision,  written policy or written procedure in
  violation of this section shall be deemed to be void and unenforceable.