New York Bans Patient ER Notice Requirements

New York lawmakers included a prudent layperson standard in an emergency care coverage law adopted in 1997.

In New York, the authors of the circular letter write, consumers who suffer severe, sudden pain have a right to seek reimbursement for emergency care if they believe their conditions might lead to serious disfigurement, serious dysfunction of body parts or serious impairment to bodily functions.

Patients also have the right to seek reimbursement for emergency care if they believe their conditions could place themselves or others in “serious jeopardy,” the regulators write.

“Although the diagnosis code may be used to approve coverage of emergency services, its use as the basis for denial of coverage is improper,” the regulators write.

The regulators concede that they have been letting carriers include post-treatment notification requirements in health insurance policies and subscriber contracts, to help carriers coordinate follow-up care and assure access to appropriate services.

Regulators have decided to eliminate notice requirements, because New York insurance laws require carriers to cover any emergency care that meets that prudent layperson law and make no mention of exceptions for patients who violate notice requirements, the regulators write.