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Health law expands consumer, provider protections


ALBANY, N.Y.--New York has adopted legislation that provides new rights to health care consumers and providers in dealing with health insurance companies.

The law, signed by Gov. Eliot Spitzer on Wednesday, limits a health plan's ability to deny care that it had already preauthorized. It also gives consumers the ability to appeal to an independent reviewer when a health plan denies a request to see an out-of-network specialist for a service not available in-network.

The law includes a cooling-off period during contract negotiations between health plans and hospitals so consumers are not unnecessarily alarmed by notices that a hospital may no longer be in a health plan's network, according to a statement issued by the governor's office.

Under the law, managed care organizations would be required to report key data on health care quality that the state Department of Health can then publish for consumers.

The law sets a limit of 15 months for hospitals to submit claims to health plans when patients have received out-of-network services.

"This is an important step ahead for making sure health care decisions are based on what is right for the patient, and for protecting patients and health care providers in dealing with health plans," New York Assembly Member Richard Gottfried said in a statement. Mr. Gottfried sponsored the legislation.

The provision regarding the cooling-off period in contract negotiations is effective immediately, while the provision allowing patients to appeal decisions to an independent reviewer will take effect April 1, 2008, a spokesman for the Department of Insurance said. The other provisions all take effect Jan. 1, 2008, the spokesman said.