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Legislative Memo

518.465.7511

BILL:

S.4297 (Spano) / A.6333 (Nolan)

Support

SUBJECT:

Administrative Resolution of Disputed Medical Bills

 

DATE:

June 4, 2001

 

The Business Council of New York State, Inc. a statewide association of more than 4000 companies, chambers of commerce, and trade associations which employ more than one million individuals, has reviewed the aforementioned legislation and opposes its enactment.

Current law provides that when an insurance carrier and a medical provider dispute a medical bill a formal arbitration process is conducted. A hearing is held before a three person arbitration panel. The three person panel consists of one member appointed by the carriers, one member appointed by the providers, and one member appointed by the Workers' Compensation Board. Both the medical provider and the insurance carrier are provided the opportunity to present oral arguments. The Business Council believes this to be a fair and consistent method of resolving claims.

The proposed legislation does away with the three person panel and replaces it with an administrative review based solely upon written submissions. The legislation provides that based on a written application by the medical provider, a determination will be made by the Workers' Compensation Board. The proposed legislation states that a medical provider will be appointed by the Workers' Compensation Board. However, there is no indication that the medical provider will be the person to perform the administrative review process and that it will not be delegated it to a clerk at the Workers' Compensation Board who has limited knowledge of the fee schedule.

Further, the legislation does not require the carrier be given an opportunity to make a written submission explaining its position on the matter. The Business of New York State, Inc. believes that this provision must be addressed in order to ensure a fair system.

The Business Council of New York State, Inc. opposes this legislation and urges that it be held.