Bill > A07292

This bill amends New York's insurance law to require health maintenance organizations (HMOs) to provide additional information when denying a medical treatment claim based on medical necessity. Specifically, when an HMO denies coverage for a particular procedure or treatment, they must either inform the insured about alternative treatment options that would be covered by their insurance or provide a detailed explanation of why the requested procedure has been ineffective in the past. The bill aims to increase transparency in healthcare coverage decisions and help patients understand their options when a medical treatment is denied. The new requirement applies to any HMO doing business in New York State and will go into effect 30 days after becoming law. This legislation seeks to give patients more clarity and support when navigating healthcare coverage decisions, potentially helping them explore alternative treatments or understand the reasoning behind a claim denial.

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https://www.nysenate.gov/legislation/bills/2025/A7292