2006 New York Code - Health insurance policies and subscriber contracts; prohibited claims

 
    * §   3231.   Health  insurance  policies  and  subscriber  contracts;
  prohibited claims. (a) For the purposes of this section the terms health
  care provider,  practitioner,  clinical  laboratory  services,  pharmacy
  services, radiation therapy services, physical therapy services or x-ray
  or  imaging  services  shall  have the same meanings as are set forth in
  section two hundred thirty-eight of the public health law.
    (b) No health care provider or practitioner may demand or request  any
  payment  for  clinical laboratory services, pharmacy services, radiation
  therapy services, physical therapy services or x-ray or imaging services
  furnished pursuant to  a  referral  prohibited  by  subdivision  one  of
  section two hundred thirty-eight-a of the public health law.
    (c)  No  insurer  shall  be  required  to pay any claim, bill or other
  demand or request for payment by a health  care  provider  for  clinical
  laboratory  services,  pharmacy  services,  radiation  therapy services,
  physical  therapy  services  or  x-ray  or  imaging  services  furnished
  pursuant  to  a  referral  prohibited  by subdivision one of section two
  hundred thirty-eight-a of the public health law.
    (d)  Every  policy  of  accident  or  health  insurance  issued  by  a
  commercial  insurer  and  every subscriber contract issued by a hospital
  service corporation,  health  service  corporation  or  medical  expense
  indemnity  corporation  which  provides coverage for clinical laboratory
  services,  pharmacy  services,  radiation  therapy  services,   physical
  therapy  services or x-ray or imaging services shall include a provision
  excluding payment of any claim, bill or  other  demand  or  request  for
  payment for such services furnished pursuant to a referral prohibited by
  subdivision  one  of  section  two  hundred thirty-eight-a of the public
  health law.
    (e) Every insurer subject to the  provisions  of  this  section  shall
  report  to  the  commissioner  of  health  any  pattern of submission of
  claims, bills or other demands or  requests  for  payment  submitted  in
  violation  of  subsection  (b) of this section, within thirty days after
  such insurer has knowledge of such pattern.
    (f) Notwithstanding the requirements of subsections (c), (d)  and  (e)
  of   this  section,  an  insurer  reimbursing  for  clinical  laboratory
  services,  pharmacy  services,  radiation  therapy  services,   physical
  therapy  services  or x-ray or imaging services is not required to audit
  or investigate any claim, bill or other demand or  request  for  payment
  for such items or services furnished pursuant to a referral.
    * NB There are 2 § 3231's