165.971 Retrospective Denial of Insurance Claims:
MSSNY will seek legislation which would amend subdivision (4) of section 4903 of the public health law and subdivision (d) of section 4903 of the insurance law which require health maintenance organizations and insurers to “make a utilization review determination involving a health care service which has been delivered within 30 days of receipt of the ‘necessary information’” to further require that in no event shall such determination be made later than 90 days from the submission of the claim. (HOD 1997-97; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
