April 1998

If Your Insurance Claim is Not Paid on Time

A new law in New York, New York Insurance law section 3224-a, requires health plans, including HMOs and other insurers, to pay an insurance claim within 45 days of the date on which a health plan receives information showing that the claim is valid. If a health plan does not meet this deadline, it must pay the claim. The plan also must pay interest of at least 12% unless the interest on the claim would be less than $2. The interest must be sent to you when the claim is paid. Claim denials and requests for more information about a claim must be sent by an insurer within 30 days after it receives the claim.

This law applies to claims submitted after January 22, 1998.

The law does not apply to people who get their insurance through "self-insured" plans. Check with someone knowledgeable about your plan to see if your plan is "self-insured". If you believe you are entitled to interest and have not received it or if you want more information about the new law, call the New York State Insurance Department Hotline at 1-800-358-9260 or write the New York Insurance Department at

New York State Insurance Department

25 Beaver Street

New York, NY 10004

or

New York State Insurance Department

Agency Building No. 1

Empire State Plaza

Albany, NY 12257

If you call the hotline with a complaint, the Insurance Department will send you a complaint form to complete. If you do not receive the complaint form, you should contact the Insurance Department again.

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