Relates to actions by health care providers against patients; provides that it shall be an affirmative defense to an action by a health care provider against a patient for recovery of payment for an outstanding bill that such health care provider failed to submit such insurance claim to the patient's insurer in a timely manner.
Summary
This bill would amend New York’s insurance law to give patients a new affirmative defense in lawsuits brought by health care providers to collect unpaid medical bills. If a provider sues a patient for payment, the patient could defend the case by showing that the provider did not submit the insurance claim to the patient’s insurer in a timely manner. In practical terms, the bill is aimed at preventing providers from shifting the cost of a bill to a patient before properly pursuing available insurance coverage.
The bill applies to civil actions brought on or after the effective date, which would be 90 days after enactment. It does not eliminate a provider’s ability to seek payment altogether, but it conditions collection efforts on the provider having timely filed the insurance claim. The measure would affect health care providers, patients, and insurers by tying debt-collection litigation to compliance with insurance billing obligations.
Impact
The bill would add a new section 3224-e to the Insurance Law and create a patient-side defense in provider collection actions. It would not directly regulate insurance coverage terms, but it would change the legal consequences of a provider’s failure to submit claims promptly, potentially reducing patient liability in billing disputes and encouraging providers to bill insurers before pursuing patients in court. The practical effect would be to influence medical debt collection practices and the timing of insurance claim submission by hospitals, physicians, and other health care providers.
Sentiment
Based on the bill text and available context, the measure appears to be consumer-protective and aimed at fairness in medical billing. There is no recorded committee debate or vote history in the provided materials, so no formal opposition or support is documented here. The bill’s framing suggests it is intended to help patients avoid being sued for bills that might have been covered by insurance if the claim had been filed properly and on time.
Contention
The main point of potential contention is whether the bill places too much burden on providers by making timely insurance submission a litigation issue, versus whether it appropriately protects patients from avoidable medical debt. Providers and their billing administrators may view the measure as adding procedural risk to collection efforts, while patient advocates are likely to support it as a safeguard against premature or improper billing. Another possible issue is how courts would determine what counts as a “timely manner” for claim submission, since the bill does not define that term in the text provided.
Relates to actions by health care providers against patients; provides that it shall be an affirmative defense to an action by a health care provider against a patient for recovery of payment for an outstanding bill that such health care provider failed to submit such insurance claim to the patient's insurer in a timely manner.
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.