165.981 Toll-Free Telephone Numbers to be Required for all Health Insurance Carriers to Provide Access for Participating Physicians:
The Medical Society of the State of New York will seek legislation or regulatory action to require PPOs and self-insured plans, as well as insurers not engaged in utilization review procedures, to provide adequate personnel to respond to telephone requests from patients and physicians. These plans should be required to have procedures that; (a) would require that adequate personnel to be available at least 40 hours per week during normal business hours to discuss patient care and allow response to telephone requests; and (b) this telephone system should be accessible on a toll-free basis for patients and physicians; and (c) that there be a toll-free telephone system capable of accepting, recording or providing instruction to incoming telephone calls during other than normal business hours and to ensure that a response to the accepted or recorded message occurs not more than one business day after the date on which the call was received; (d) and that where a plan does not provide for such reasonable and adequate access, the eligibility of a patient with an identification care from the plan will be deemed valid. (HOD 1997-56; Reaffirmed HOD 2000-272; Reaffirmed HOD 2009-259; Reaffirmed HOD 2019)
