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N.Y. Financial Services Law § 608

Payment for independent dispute resolution entity

Redline — January 1, 2015 → current.View current text →
Current — June 29, 2026
As of January 1, 2015
* § 608. Payment for independent dispute resolution entity. (a) For\ndisputes involving an insured, when the independent dispute resolution\nentity determines the health care plan's payment is reasonable, payment\nfor the dispute resolution process shall be the responsibility of the\nnon-participating physician. When the independent dispute resolution\nentity determines the non-participating physician's fee is reasonable,\npayment for the dispute resolution process shall be the responsibility\nof the health care plan. When a good faith negotiation directed by the\nindependent dispute resolution entity pursuant to paragraph four of\nsubsection (a) of section six hundred five of this article, or paragraph\nsix of subsection (a) of section six hundred seven of this article\nresults in a settlement between the health care plan and\nnon-participating physician, the health care plan and the\nnon-participating physician shall evenly divide and share the prorated\ncost for dispute resolution.\n (b) For disputes involving a patient that is not an insured, when the\nindependent dispute resolution entity determines the physician's fee is\nreasonable, payment for the dispute resolution process shall be the\nresponsibility of the patient unless payment for the dispute resolution\nprocess would pose a hardship to the patient. The superintendent shall\npromulgate a regulation to determine payment for the dispute resolution\nprocess in cases of hardship. When the independent dispute resolution\nentity determines the physician's fee is unreasonable, payment for the\ndispute resolution process shall be the responsibility of the physician.\n * NB Effective March 31, 2015\n
§ 608. Payment for independent dispute resolution entity. (a) For\ndisputes involving an insured, when the independent dispute resolution\nentity determines the health care plan's payment is reasonable, payment\nfor the dispute resolution process shall be the responsibility of the\nnon-participating provider. When the independent dispute resolution\nentity determines the non-participating provider's fee is reasonable,\npayment for the dispute resolution process shall be the responsibility\nof the health care plan. When a good faith negotiation directed by the\nindependent dispute resolution entity pursuant to paragraph four of\nsubsection (a) of section six hundred five of this article, or paragraph\nsix of subsection (a) of section six hundred seven of this article\nresults in a settlement between the health care plan and\nnon-participating provider, the health care plan and the\nnon-participating provider shall evenly divide and share the prorated\ncost for dispute resolution.\n * (b) For disputes involving a patient that is not an insured, when\nthe independent dispute resolution entity determines the physician's fee\nis reasonable, payment for the dispute resolution process shall be the\nresponsibility of the patient unless payment for the dispute resolution\nprocess would pose a hardship to the patient. The superintendent shall\npromulgate a regulation to determine payment for the dispute resolution\nprocess in cases of hardship. When the independent dispute resolution\nentity determines the physician's fee is unreasonable, payment for the\ndispute resolution process shall be the responsibility of the physician.\n * NB Effective until August 26, 2026\n * (b) (1) A non-participating provider and a health care plan shall\nsubmit full payment for the dispute resolution process upon submission\nof the dispute resolution application or, if the responding party, when\nresponding to the independent dispute resolution entity's request for\neligibility information and supporting documents.\n (2) An independent dispute resolution entity shall not comingle the\npayments for the dispute resolution process with any other funds held by\nthe entity and shall hold all payments in a separate account.\n (3) An independent dispute resolution entity shall issue a refund of\nthe dispute resolution process payment to the prevailing party within\nthirty days of rendering a determination on the dispute or rejecting the\ndispute as ineligible.\n * NB Effective August 26, 2026\n * (c) For disputes involving a patient that is not an insured, when\nthe independent dispute resolution entity determines the physician's fee\nis reasonable, payment for the dispute resolution process shall be the\nresponsibility of the patient unless payment for the dispute resolution\nprocess would pose a hardship to the patient. The superintendent shall\npromulgate a regulation to determine payment for the dispute resolution\nprocess in cases of hardship. When the independent dispute resolution\nentity determines the physician's fee is unreasonable, payment for the\ndispute resolution process shall be the responsibility of the physician.\n * NB Effective August 26, 2026\n

Official source: NYS Open Legislation (New York State Senate). Reproduced from public-domain New York statutes; confirm against the official source for the current text. Not legal advice.