120.000 HEALTH INSURANCE COVERAGE

120.961          Impediments to Obtaining Pre-authorizations for Medically Indicated Diagnostic Tests: MSSNY will take appropriate steps including, if necessary, seeking the enactment of legislation and regulation, to eliminate unnecessary impediments imposed by health insurance companies to obtaining pre-authorization, including reducing the need and time for obtaining pre-authorization. (Council 3/3/08; Reaffirmed HOD 2014-58;

120.960           Assuring Seamless Coverage for Patients Changed from HMOroducts into PPO Products:  SUNSET HOD 2019  

120.959            Revision of the Federal Tort Claims Act: MSSNY will endorse the proposal that all patients whose care is funded in all or in part by federal funds, and/or whose care is delivered in facilities funded in all or in part by federal funds, such as those patients covered by

120.958           Eligibility for Enrollment in Family Health Plus: SUNSET HOD 2019

120.913           Qualified Physicians on Preauthorization Phone Lines The Medical Society of the State of New York will seek legislation or regulation requiring that prescribers be able to reach a qualified medical person promptly (within 10 minutes) on all telephone calls to third-party carriers for precertification, appeals, etc. and that the personnel qualified to adjudicate these

120.936             Requiring Insurance Companies to Cover ADD/ADHD Medications For children who have already previously been successfully stabilized on a specific ADD/ADHD medication, the Medical Society of the State of New York (MSSNY) will pursue legislation and/or regulation that requires an insurer to continue to cover, at lowest tier cost, or

120.957           Outsourcing of Claims: MSSNY will take all appropriate steps including, if necessary, the passage of legislation to assure that health insurance companies which subcontract with third party vendor(s) located in a foreign country for claims processing, utilization review or for any other service adhere to all appropriate federal and state legal requirements for the

120.956           Out-of-Network Care by Health Plan Providers: MSSNY will petition health plans as well as the New York State Insurance Department to allow the health plan’s physician to charge a subscriber as an out-of-network provider when the subscriber is not an enrolled member of the physician’s specifically contracted health plan product. (HOD 2009-262; Reaffirmed HOD

120.955           Truth in Out-of-Network Healthcare Benefits Act: MSSNY will continue to seek enforcement of the law requiring insurance companies to provide to potential purchasers the true expected out-of-pocket costs if patients to out of network.  (HOD 2010-58; Amended and reaffirmed HOD 2020)

120.954           Child Health Plus Program Funding: MSSNY will continue to work with New York’s Congressional Delegation and the AMA to assure that federal funding for care provided to beneficiaries of the Child Health Plus and Medicaid programs in New York is not diminished in the future.  (HOD 2010-91; Reaffirmed HOD 2020)