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February 03, 2002 at 07:00 PM
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The New York State Insurance Department is banning emergency care notice requirements in state-regulated health insurance policies and subscriber contracts.
Carriers can ask insureds to tell them about emergency room visits, and deny coverage when insureds go for symptoms that would not lead a “prudent layperson” to seek emergency care, the department says.
But a carrier must base denial decisions on the symptoms, not the diagnosis, and it cannot use violations of notice requirements as a reason to deny or reduce benefits, the department says.
“To deny or reduce benefits on this basis would be inconsistent with the Insurance Law,” department officials write in Circular Letter Number 1 (2002).
