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NY regulator limiting healthcare insurers' out-of-state reimbursement


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NY regulator limiting healthcare insurers' out-of-state reimbursement

New York Financial Services Superintendent Maria Vullo has finalized a regulation to limit the amount insurers can reimburse for healthcare services executed outside of New York State under its no-fault insurance law.

The Department of Financial Services found that some healthcare providers charged the prevailing fee in areas outside New York that were higher than the limits New York imposes on healthcare services, a practice the regulator said led to higher premiums, inflated claims and depleted coverage.

The new regulation is aimed at eradicating the practice and its resulting disadvantage to consumers, said Vullo.

The final regulations demands that when a professional healthcare service reimbursable under the no-fault law is performed outside of New York to an injured a New York resident, the amount that the insurer can reimburse for the service cannot exceed that of the New York region that has the highest value in the no-fault fee schedule for the service.

No-fault insurance law provides for reimbursement of medical expenses and lost wages for a policyholder injured in an automobile accident regardless of who is at fault.