New Law Creates Prior Authorization Exceptions for Medically Timely and Related Healthcare Services
Governor Andrew M. Cuomo today signed legislation (S.5328-A/A.2880-B) to ensure health insurers do not deny coverage for urgent and medically necessary procedures and treatments. The law expands prior authorization exceptions and requires insurance companies to cover additional services and procedures related to existing surgical or other invasive procedures, concurrent symptoms and associated side effects.
"When a doctor encounters unexpected complications during a surgical procedure or realizes additional treatment is immediately necessary if a patient is undergoing chemotherapy, they don't have time to stop and wait for a new authorization from insurance companies - they need to act quickly to help the patient," Governor Cuomo said. "This new law will help ensure health plans can no longer deny healthcare coverage for any medically necessary services or procedures just because they were not pre-authorized by the insurance company, and will help patients in a medically compromised state get the treatments they need quickly."
Senator Neil D. Breslin, Chair of the Senate Insurance Committee, said, "This important consumer protection legislation puts patients first, particularly those who are in a medically compromised state. This new law ensures that patients receive the medically necessary services their health care provider feels is integral to improving their short and long-term health."
Assembly Member Pamela J. Hunter said, "Pre-authorization should be the last thing a patient has to be concerned about during a procedure. Expanding pre-authorization exceptions for these purposes will allow medical professionals to properly perform their duties and lead to better patient outcomes."
This new law will help ensure when a provider encounters unexpected complications, such as during a surgical procedure or other treatment such as chemotherapy, and realizes additional treatment is immediately necessary, they do not have to stop and wait for a new pre-authorization, leaving the patient with unmet needs and in a potentially dangerous situation. This law also builds on Governor Cuomo's leadership to expand health insurance coverage and improve health care for all New Yorkers.
This new law will take effect in 90 days.