N.Y. Insurance Law § 4916: Oversight and surveillance of the external appeal process

§ 4916. Oversight and surveillance of the external appeal process. (a)

The superintendent shall have the power to:

(1) review the activities of the health care plans and external appeal

agents pursuant to this title, including the extent to which such plans

and agents adhere to the standards and time frames required pursuant to

this title;

(2) investigate complaints by insureds regarding requests for and

processing of external appeals; and

(3) conduct random audits of health care plans and external appeal

agents to determine compliance with the provisions of this title.

(b) Each health care plan and external appeal agent shall annually, in

such form as the superintendent shall require, report the number of

external appeals requested by insureds and the outcomes of any such

external appeals.

(c) The superintendent shall annually report, by plan and by agent,

such information to the governor and the legislature, provided that no

such information shall be included which would otherwise be deemed

confidential information within the meaning of this chapter.