New York § 4915 Prohibited practices

New York Statutes

§ 4915 — Prohibited practices

New York § 4915

Law ISCInsurance

Title 2Right to External Appeal

Art. 49Utilization Review and External Appeal

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Bluebook

N.Y. Insurance § 4915 (2026).

Text

  § 4915. Prohibited practices. An external appeal agent shall not, with\nrespect to external appeal activities, permit or provide compensation or\nanything of value to its employees, agents, or contractors based on:\n  (a) either a percentage of the amount by which a claim is reduced for\npayment or the number of claims or the cost of services for which the\nperson has denied authorization or payment; or\n  (b) any other method that encourages the upholding of an adverse\ndetermination.\n

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§ 4915. Prohibited practices. An external appeal agent shall not, with\nrespect to external appeal activities, permit or provide compensation or\nanything of value to its employees, agents, or contractors based on:\n (a) either a percentage of the amount by which a claim is reduced for\npayment or the number of claims or the cost of services for which the\nperson has denied authorization or payment; or\n (b) any other method that encourages the upholding of an adverse\ndetermination.\n