New York § 4916 Oversight and surveillance of the external appeal process

New York Statutes

§ 4916 — Oversight and surveillance of the external appeal process

New York § 4916

Law ISCInsurance

Title 2Right to External Appeal

Art. 49Utilization Review and External Appeal

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Bluebook

N.Y. Insurance § 4916 (2026).

Text

§ 4916. Oversight and surveillance of the external appeal process.

(a)\nThe superintendent shall have the power to:\n (1) review the activities of the health care plans and external appeal\nagents pursuant to this title, including the extent to which such plans\nand agents adhere to the standards and time frames required pursuant to\nthis title;\n (2) investigate complaints by insureds regarding requests for and\nprocessing of external appeals; and\n (3) conduct random audits of health care plans and external appeal\nagents to determine compliance with the provisions of this title.\n (b) Each health care plan and external appeal agent shall annually, in\nsuch form as the superintendent shall require, report the number of\nexternal appeals requested by insureds and the outcomes of any

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§ 4916. Oversight and surveillance of the external appeal process. (a)\nThe superintendent shall have the power to:\n (1) review the activities of the health care plans and external appeal\nagents pursuant to this title, including the extent to which such plans\nand agents adhere to the standards and time frames required pursuant to\nthis title;\n (2) investigate complaints by insureds regarding requests for and\nprocessing of external appeals; and\n (3) conduct random audits of health care plans and external appeal\nagents to determine compliance with the provisions of this title.\n (b) Each health care plan and external appeal agent shall annually, in\nsuch form as the superintendent shall require, report the number of\nexternal appeals requested by insureds and the outcomes of any such\nexternal appeals.\n (c) The superintendent shall annually report, by plan and by agent,\nsuch information to the governor and the legislature, provided that no\nsuch information shall be included which would otherwise be deemed\nconfidential information within the meaning of this chapter.\n