BILL NUMBER: S5209
SPONSOR: SCARCELLA-SPANTON
 
TITLE OF BILL:
An act to amend the insurance law, in relation to limiting the lookback
period for insurance overpayment recovery from health care providers
 
PURPOSE OR GENERAL IDEA OF BILL:
This bill amends section 3224-b(b) of the Insurance Law by setting the
overpayment recovery effort window for health plans to three months.
 
JUSTIFICATION:
This legislation seeks to address some of the difficulties faced by
healthcare providers when dealing with health insurance plans. Under
current law, an insurance company must pay a claim within 45 days of
submission. However, once a claim is paid, an insurance company can
still seek to recover this payment for up to two years after the claim
was made. Insurance companies can withhold money owed to health care
providers in an attempt to collect alleged overpayments from past
patient daims. Health care providers must make the difficult choice of
going through the expense and hassle of examining old records to verify
the service and payment or concede to the insurance company's demands.
Insurance company resources far exceed that of the average health care
provider.This lengthy review period is unfair and cumbersome for health
care providers.
This legislation would change the look back window for insurance compa-
nies to seek to recover an overpayment to three months. This change will
establish fair, uniform and consistent procedures for the processing of
overpayment recovery claims for all health care providers.
 
PRIOR LEGISLATIVE HISTORY:
2024; Held in Senate Insurance Committee.
 
FISCAL IMPLICATIONS:
None
 
EFFECTIVE DATE:
This act would take effect on the thirtieth day after it shall have
become law.

Statutes affected:
S5209: 3224-b insurance law, 3224-b(b) insurance law