Requires insurers to provide insurance coverage for treatment of rare diseases, life-threatening conditions or diseases, degenerative and disabling conditions, or diagnoses involving medically fragile children, by a provider of the patient's choice.
Summary
Bill S00965 amends the insurance law and public health law in New York to require insurance policies that provide hospital, surgical, medical, or major medical coverage to include provisions for coverage of medically necessary services related to rare diseases, life-threatening conditions, degenerative and disabling conditions, and care for medically fragile children. The bill allows patients to seek care from providers outside their insurance network if certain conditions are met, including cost comparability and a recommendation from their primary care physician or specialist. The bill aims to enhance access to specialized care for patients with complex medical needs.
Impact
This legislation will significantly alter the landscape of health insurance coverage in New York by mandating that insurers provide coverage for out-of-network providers under specific circumstances. It will ensure that patients with rare or life-threatening conditions have access to necessary treatments without the constraints of network limitations, thereby potentially increasing the quality of care and patient outcomes. The bill also aligns state insurance laws with the needs of medically fragile children and individuals with degenerative conditions, promoting a more inclusive healthcare environment.
Sentiment
The sentiment surrounding Bill S00965 appears to be largely supportive, as it addresses critical healthcare needs for vulnerable populations. However, there may be concerns regarding the financial implications for insurance providers and the potential for increased costs associated with expanded coverage options. The lack of recorded votes or detailed committee discussions suggests that the bill's reception may still be under evaluation.
Contention
Notable points of contention may arise from insurance companies regarding the financial impact of mandated coverage for out-of-network services, as well as concerns about the administrative burden of implementing such changes. Advocates for patients with rare diseases and medically fragile children are likely to support the bill, while some insurers may oppose it due to potential increases in premiums or operational complexities.
Same As
Requires insurers to provide insurance coverage for treatment of rare diseases, life-threatening conditions or diseases, degenerative and disabling conditions, or diagnoses involving medically fragile children, by a provider of the patient's choice.
Requires insurers to provide insurance coverage for treatment of rare diseases, life-threatening conditions or diseases, degenerative and disabling conditions, or diagnoses involving medically fragile children, by a provider of the patient's choice.
Establishes the clinical trial access and education fund to provide grants to eligible applicants to provide certain services for patients with life-threatening or disabling conditions or diseases.