A 7292: Directs a health maintenance organization which denies a claim due to absence of medical necessity to inform the insured as to preferred alternative treatment, or provide the insured with a statement as to the past ineffectiveness of the requested procedure or treatment.

  
  STATE OF NEW YORK ________________________________________________________________________ 7292 2025-2026 Regular Sessions  IN ASSEMBLY March 25, 2025 ___________ Introduced by M. of A. PRETLOW -- read once and referred to the Commit- tee on Insurance AN ACT to amend the insurance law, in relation to notice by health main- tenance organizations that a request for coverage of a particular treatment is denied The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The insurance law is amended by adding a new section 2601-a 2 to read as follows: 3 § 2601-a. Denial of coverage or treatment by a health maintenance 4 organization. Whenever a health maintenance organization, doing business 5 in this state, denies a claim for coverage of a particular procedure or 6 treatment because such procedure or treatment is not medically neces- 7 sary, the health maintenance organization shall inform the insured as to 8 those preferred procedure or treatment options which would be covered, 9 or provide the insured with a statement as to the past ineffectiveness 10 of the requested procedure or treatment. 11 § 2. This act shall take effect on the thirtieth day after it shall 12 have become a law. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11000-01-5