New York Insurance Law Section 3217-D - Grievance procedure and access to specialty care.

  3217-d.  Grievance  procedure  and access to specialty care. (a) An
  insurer that issues a comprehensive policy that utilizes  a  network  of
  providers and is not a managed care health insurance contract as defined
  in  subsection  (c)  of  section four thousand eight hundred one of this
  chapter shall establish and maintain a  grievance  procedure  consistent
  with the requirements of section four thousand eight hundred two of this
  chapter.
(b)  An  insurer  that  issues  a comprehensive policy that utilizes a
  network of providers and is not a managed care health insurance contract
  as defined in subsection (c) of section four thousand eight hundred  one
  of this chapter and requires that specialty care be provided pursuant to
  a  referral  from  a  primary care provider shall provide access to such
  specialty care consistent with the requirements of subsections (b),  (c)
  and  (d)  of  section  four thousand eight hundred four of this chapter;
  provided, however, that nothing in this section shall  be  construed  to
  require  that  an  insurer,  or a primary care provider on behalf of the
  insurer, make a referral to a provider that  is  not  in  the  insurer's
  network.
(c)  An  insurer  that  issues  a comprehensive policy that utilizes a
  network of providers and is not a managed care health insurance contract
  as defined in subsection (c) of section four thousand eight hundred  one
  of  this  chapter  shall  provide access to transitional care consistent
  with the requirements  of  subsections  (e)  and  (f)  of  section  four
  thousand eight hundred four of this chapter.
(d)  An  insurer  that  issues  a comprehensive policy that utilizes a
  network of providers and is not a managed care health insurance contract
  as defined in subsection (c) of section four thousand eight hundred  one
  of  this  chapter,  shall  provide  access  to  out-of-network  services
  consistent with the requirements  of  subsection  (a)  of  section  four
  thousand eight hundred four of this chapter, subsections (g-6) and (g-7)
  of section four thousand nine hundred of this chapter, subsections (a-1)
  and  (a-2)  of  section four thousand nine hundred four of this chapter,
  paragraphs three and four of subsection (b)  of  section  four  thousand
  nine  hundred  ten  of  this  chapter,  and subparagraphs (C) and (D) of
  paragraph four of subsection (b) of section four thousand  nine  hundred
  fourteen of this chapter.

Last modified: February 3, 2019