265.959 Insurance Companies Should Reimburse Physicians for Telephone Time with Pharmacies:
MSSNY will seek regulatory or legislative action to (a) require health care plans doing business in New York State to recognize, as a separate service, through the existing AMA-CPT coding nomenclature, telephone calls communicating with family members, medical entities, pharmacies, benefit management companies, case managers, and others as required for patient management and care; (b) require health care plans in New York State to disclose in the health plan’s benefit package that telephone management services for patients, as well as the time spent placing the phone call(s) is a separate service and specify whether the service is a covered or non-covered service.
If telephone management for patients, and the time spent making the phone call(s) is deemed to be a non-covered service, MSSNY will seek regulatory or legislative relief which would require health care plans to honor an Advance Notification Agreement between the physician and the patient through a formal Waiver of Liability, whereby payment for this service becomes the responsibility of the patient.
MSSNY will seek regulatory or legislative action mandating the provision of toll-free telephone and FAX numbers for physician use by all health care plans, products and mail order pharmacies doing business in New York State. Said legislation or regulation will include a provision that the waiting time for physicians and their office staff required by the payers to use these toll-free telephone numbers be no more than five (5) to ten (10) minutes. (HOD 2000-252; Reaffirmed 2014 HOD; Reaffirmed HOD 2015-56; Reaffirmed HOD 2025)
