In these very difficult times in the health care arena, doctors who are not associated with a health care network are being squeezed by insurance companies and self-funded health plans more than ever, thus negatively impacting on patient care. Insurance carriers attempt to limit patient access to out-of-network coverage and want to force practicing physicians into the contractually cozy confines of their in-network world to control costs. Thus, the aim of physicians collecting the usual and customary rate (or anything remotely close) for their out-of-network services, even if they comply with New York FAIR Health guidelines (an independent database providing rates physicians regularly use when billing patients and insurers for out-of-network services), is far from guaranteed. As for patients, their choice of doctors and treatment is increasingly under attack even when they pay insurance companies high premiums to allow them to avail themselves of out-of-network coverage.
Insurance Law §3224-a, known as the Prompt Pay Law, purportedly imposed standards on insurers for the “prompt, fair and equitable” payment of claims for health care services for the benefit of patients as well as those physicians that treat them. Originally passed in 1997, the statute sets forth time frames within which an insurer must either pay a claim, notify the claimant of the reason for denying a claim, or request additional information. An insurer that fails to comply with the provisions of the Prompt Pay Law is obligated to pay the full amount of the claim, with interest at 12 percent as required by a companion bill passed the same day as the Prompt Pay Law.1
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