N.Y. Financial Services Law § 602 Applicability

• Library: New York Statutes
• Edition: 2023
• Currency: Current through 2023 NY Law Chapter 682

(a) This article shall not apply to health care services, including emergency services, where physician fees are subject to schedules or other monetary limitations under any other law, including the workers' compensation law and article fifty-one of the insurance law, and shall not preempt any such law.

(b)

(1) With regard to emergency services billed under American medical association current procedural terminology (CPT) codes 99281 through 99285, 99288, 99291 through 99292, 99217 through 99220, 99224 through 99226, and 99234 through 99236, the dispute resolution process established in this article shall not apply when:

(A) the amount billed for any such CPT code meets the requirements set forth in paragraph three of this subsection, after any applicable co-insurance, co-payment and deductible; and

(B) the amount billed for any such CPT code does not exceed one hundred twenty percent of the usual and customary cost for such CPT code.

(2) The health care plan shall ensure that an insured shall not incur any greater out-of-pocket costs for emergency services billed under a CPT code as set forth in this subsection than the insured would have incurred if such emergency services were provided by a participating physician.