N.Y. Insurance Law § 5108: Limit on charges by providers of health services

§ 5108. Limit on charges by providers of health services. (a) The

charges for services specified in paragraph one of subsection (a) of

section five thousand one hundred two of this article and any further

health service charges which are incurred as a result of the injury and

which are in excess of basic economic loss, shall not exceed the charges

permissible under the schedules prepared and established by the chairman

of the workers' compensation board for industrial accidents, except

where the insurer or arbitrator determines that unusual procedures or

unique circumstances justify the excess charge.

(b) The superintendent, after consulting with the chairman of the

workers' compensation board and the commissioner of health, shall

promulgate rules and regulations implementing and coordinating the

provisions of this article and the workers' compensation law with

respect to charges for the professional health services specified in

paragraph one of subsection (a) of section five thousand one hundred two

of this article, including the establishment of schedules for all such

services for which schedules have not been prepared and established by

the chairman of the workers' compensation board.

(c) No provider of health services specified in paragraph one of

subsection (a) of section five thousand one hundred two of this article

may demand or request any payment in addition to the charges authorized

pursuant to this section. Every insurer shall report to the commissioner

of health any patterns of overcharging, excessive treatment or other

improper actions by a health provider within thirty days after such

insurer has knowledge of such pattern.