State Senator Urges DFS to Admonish Insurers to Address and Prevent Specious Medical Record Requests
New York State Senate Insurance Committee Chair Neil Breslin has written to NY Financial Services Superintendent Adrienne Harris urging that DFS “resolve the many physician complaints that have been made regarding health plans regularly making unreasonable demands for medical records that delay claim payment in violation of New York’s Prompt Payment Law”. MSSNY has brought this problem to attention of various state officials and the State Legislature.
Senator Breslin’s letter acknowledges health insurers’ responsibility to investigate claims to ensure they are properly billed. However, he raises concerns that the frequency by which these medical records requests occur, “based upon the sheer volume of complaints regarding delayed claims, suggest a potentially more pernicious purpose for these requests.” He further goes on to note that “While we want insurers to be on guard against fraud and abuse, we must also guard against insurers using vague or unsupported concerns to allow them to delay obligations under the Prompt Payment Law by using pretextual medical record requests.”
In addition to urging DFS to act to resolve the myriad of physician complaints, the letter notes a number of legislative proposals being considered by Senator Breslin as DFS continues to investigate. The list includes: increasing the penalties and interest that can be imposed on health insurers; providing DFS authority to exponentially increase penalties for patterns of inappropriate conduct; providing DFS authority to impose penalties on the various subcontractors that health insurers rely upon for claim review; and requiring health insurers to articulate the specific reasons why a medical record request has occurred in processing a claim.
MSSNY is appreciative to Senator Breslin for taking these important steps towards resolving an intractable problem that is adversely affecting the viability of many physician practices across the State.
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