265.999 Third Party Reimbursement Mechanism: MSSNY recognizes the validity of a pluralistic approach to third party reimbursement methodology and that indemnity, as well as UCR, have positive aspects which merit further study. It will continue its analysis of the merits of indemnity, service benefits, UCR, capitation, salary and other approaches to reimbursement of physicians. The
265.998 “No Fault” Accident Victims: MSSNY continues to support legislation and all other means to amend the “no fault law” to ensure that physicians and hospitals are paid regardless of the involvement of alcohol as possible cause of the accident which resulted in the injury being treated. (HOD 1992-34; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
265.997 Benefits Denial by HMOs and Third Party Carriers: SUNSET HOD 2013
265.996 Reimbursement Based on Outcome: SUNSET HOD 2014
265.995 Balance Billing – Benefits in Health System Reform: MSSNY supports the position that the practice of Balance Billing is in the best interest of: (1) Patients who will assume personal responsibility for a portion of their health care cost, and (2) Physicians and other providers who will be able to bill for an appropriate
265.994 Determination of Where Medically Necessary Services Are to be Provided to Patients Enrolled in Managed Care Entities: MSSNY has adopted the position that in the event that a patient enrolled in a managed care program is referred to the emergency room of a local hospital following direct or verbal contact with a participating physician,
265.993 Denial of Payments, “No Fault” Insurance Carriers: SUNSET HOD 2014; See 265.998
265.992 Reimbursement of Alternative Therapies By HMOs: MSSNY will support legislative action to prevent insurance coverage by managed care companies for unproven alternative therapies and unlicensed practitioners. (HOD 1997-163; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
265.991 Physicians Should Be Informed By the Third Party Payor of the Reason for the Denial of the Claim: MSSNY will seek the appropriate legislative or regulatory means to require that all third party payors, licensed to operate in New York State, be required to provide in a timely manner to the physicians with a rejected
265.990 Denial of Claims: MSSNY will seek to have legislation introduced that will require carriers to send a copy of their examiner’s report to the treating physician with a provision that the denial cannot be issued until seven working days have passed from the time the report is mailed to the treating physician. (HOD 1997-263;
