§ 3231*2 — Health insurance policies and subscriber contracts; prohibited claims

* § 3231. Health insurance policies and subscriber contracts;\nprohibited claims. (a) For the purposes of this section the terms health\ncare provider, practitioner, clinical laboratory services, pharmacy\nservices, radiation therapy services, physical therapy services or x-ray\nor imaging services shall have the same meanings as are set forth in\nsection two hundred thirty-eight of the public health law.\n (b) No health care provider or practitioner may demand or request any\npayment for clinical laboratory services, pharmacy services, radiation\ntherapy services, physical therapy services or x-ray or imaging services\nfurnished pursuant to a referral prohibited by subdivision one of\nsection two hundred thirty-eight-a of the public health law.\n (c) No insurer shall be required to pay any claim, bill or other\ndemand or request for payment by a health care provider for clinical\nlaboratory services, pharmacy services, radiation therapy services,\nphysical therapy services or x-ray or imaging services furnished\npursuant to a referral prohibited by subdivision one of section two\nhundred thirty-eight-a of the public health law.\n (d) Every policy of accident or health insurance issued by a\ncommercial insurer and every subscriber contract issued by a hospital\nservice corporation, health service corporation or medical expense\nindemnity corporation which provides coverage for clinical laboratory\nservices, pharmacy services, radiation therapy services, physical\ntherapy services or x-ray or imaging services shall include a provision\nexcluding payment of any claim, bill or other demand or request for\npayment for such services furnished pursuant to a referral prohibited by\nsubdivision one of section two hundred thirty-eight-a of the public\nhealth law.\n (e) Every insurer subject to the provisions of this section shall\nreport to the commissioner of health any pattern of submission of\nclaims, bills or other demands or requests for payment submitted in\nviolation of subsection (b) of this section, within thirty days after\nsuch insurer has knowledge of such pattern.\n (f) Notwithstanding the requirements of subsections (c), (d) and (e)\nof this section, an insurer reimbursing for clinical laboratory\nservices, pharmacy services, radiation therapy services, physical\ntherapy services or x-ray or imaging services is not required to audit\nor investigate any claim, bill or other demand or request for payment\nfor such items or services furnished pursuant to a referral.\n * NB There are 2 § 3231's\n