New York Assembly Bill A08172

New York 2025-2026 Regular Session

• Introduced: 5/5/25
• Refer: 5/5/25

Caption

Relates to establishing timeframes for the payment of claims to hospitals.

Impact

The bill has significant implications for both healthcare providers and insurance payors. By mandating timely payments and stipulating that medical necessity reviews occur post-payment rather than before, it seeks to alleviate financial pressures on hospitals and ensure they are compensated for services promptly. It impacts existing statutes governing the relationship between payors and providers by formalizing a structured process for claims management and review.

Summary

Bill A08172, introduced in the New York Assembly, aims to amend the insurance law to establish specific timeframes for insurance companies and payors to process and pay claims submitted by hospitals. Under this bill, insurers are obligated to pay claims at the contracted rate without regard to their internal medical necessity policies for a set period after claims are submitted. This approach is intended to streamline the payment process and ensure that hospitals receive timely compensation for the services rendered to patients, regardless of ensuing disputes over medical necessity.

Contention

Notable points of contention surrounding A08172 include concerns from insurance companies regarding their ability to evaluate claims based on medical necessity, which could lead to higher costs if hospitals submit unjustified claims. Advocates for the bill argue that the requirement for timely payments is crucial for the sustainability of healthcare providers, particularly smaller and rural hospitals that may suffer from cash flow issues. Opponents, however, emphasize the risk of potential misuse of services without stricter prepayment reviews, which could inflate healthcare costs overall.