N.Y. Financial Services Law § 608: Payment for independent dispute resolution entity

§ 608. Payment for independent dispute resolution entity. (a) For

disputes involving an insured, when the independent dispute resolution

entity determines the health care plan's payment is reasonable, payment

for the dispute resolution process shall be the responsibility of the

non-participating provider. When the independent dispute resolution

entity determines the non-participating provider's fee is reasonable,

payment for the dispute resolution process shall be the responsibility

of the health care plan. When a good faith negotiation directed by the

independent dispute resolution entity pursuant to paragraph four of

subsection (a) of section six hundred five of this article, or paragraph

six of subsection (a) of section six hundred seven of this article

results in a settlement between the health care plan and

non-participating provider, the health care plan and the

non-participating provider shall evenly divide and share the prorated

cost for dispute resolution.

* (b) For disputes involving a patient that is not an insured, when

the independent dispute resolution entity determines the physician's fee

is reasonable, payment for the dispute resolution process shall be the

responsibility of the patient unless payment for the dispute resolution

process would pose a hardship to the patient. The superintendent shall

promulgate a regulation to determine payment for the dispute resolution

process in cases of hardship. When the independent dispute resolution

entity determines the physician's fee is unreasonable, payment for the

dispute resolution process shall be the responsibility of the physician.

* NB Effective until August 26, 2026

* (b) (1) A non-participating provider and a health care plan shall

submit full payment for the dispute resolution process upon submission

of the dispute resolution application or, if the responding party, when

responding to the independent dispute resolution entity's request for

eligibility information and supporting documents.

(2) An independent dispute resolution entity shall not comingle the

payments for the dispute resolution process with any other funds held by

the entity and shall hold all payments in a separate account.

(3) An independent dispute resolution entity shall issue a refund of

the dispute resolution process payment to the prevailing party within

thirty days of rendering a determination on the dispute or rejecting the

dispute as ineligible.

* NB Effective August 26, 2026

* (c) For disputes involving a patient that is not an insured, when

the independent dispute resolution entity determines the physician's fee

is reasonable, payment for the dispute resolution process shall be the

responsibility of the patient unless payment for the dispute resolution

process would pose a hardship to the patient. The superintendent shall

promulgate a regulation to determine payment for the dispute resolution

process in cases of hardship. When the independent dispute resolution

entity determines the physician's fee is unreasonable, payment for the

dispute resolution process shall be the responsibility of the physician.

* NB Effective August 26, 2026