N.Y. Insurance Law § 3231*2: Health insurance policies and subscriber contracts; prohibited claims

* § 3231. Health insurance policies and subscriber contracts;

prohibited claims. (a) For the purposes of this section the terms health

care provider, practitioner, clinical laboratory services, pharmacy

services, radiation therapy services, physical therapy services or x-ray

or imaging services shall have the same meanings as are set forth in

section two hundred thirty-eight of the public health law.

(b) No health care provider or practitioner may demand or request any

payment for clinical laboratory services, pharmacy services, radiation

therapy services, physical therapy services or x-ray or imaging services

furnished pursuant to a referral prohibited by subdivision one of

section two hundred thirty-eight-a of the public health law.

(c) No insurer shall be required to pay any claim, bill or other

demand or request for payment by a health care provider for clinical

laboratory services, pharmacy services, radiation therapy services,

physical therapy services or x-ray or imaging services furnished

pursuant to a referral prohibited by subdivision one of section two

hundred thirty-eight-a of the public health law.

(d) Every policy of accident or health insurance issued by a

commercial insurer and every subscriber contract issued by a hospital

service corporation, health service corporation or medical expense

indemnity corporation which provides coverage for clinical laboratory

services, pharmacy services, radiation therapy services, physical

therapy services or x-ray or imaging services shall include a provision

excluding payment of any claim, bill or other demand or request for

payment for such services furnished pursuant to a referral prohibited by

subdivision one of section two hundred thirty-eight-a of the public

health law.

(e) Every insurer subject to the provisions of this section shall

report to the commissioner of health any pattern of submission of

claims, bills or other demands or requests for payment submitted in

violation of subsection (b) of this section, within thirty days after

such insurer has knowledge of such pattern.

(f) Notwithstanding the requirements of subsections (c), (d) and (e)

of this section, an insurer reimbursing for clinical laboratory

services, pharmacy services, radiation therapy services, physical

therapy services or x-ray or imaging services is not required to audit

or investigate any claim, bill or other demand or request for payment

for such items or services furnished pursuant to a referral.

* NB There are 2 § 3231's