Issue:  2007-01-29

Bill Seeks to Protect HC Professionals Participation in Managed Care Plans

♦ New York

ALBANY, N.Y., January 29 – Legislation amending the Insurance Law with respect to termination of a health care professionals participation in a managed care plan was introduced in the New York State Assembly.

Under the measure, introduced by Assemblyman Adam T. Bradley (D-Westchester), insurers would not be able to terminate or refuse renewal of the in-network benefits portion of an insurers network solely because the health care professional is credentialed only at a hospital or hospitals no longer participating in the in-network benefits portion of the insurers network.

Physicians, as well as patients, are being penalized by such arbitrary restrictions arising from disputes between insurers and hospitals, disputes that have nothing to do with a physicians right to maintain in-network privileges for his or her patients, Bradley said. Patients are subsequently faced with leaving their physician of choice, [who has] provided them care for extended periods of time.

He added, Permitting such tactics, strategically used by many health insurers, serves only to drive up health care costs and limit a patients ability to select the qualified provider of his or her choice.

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