N.Y. Comp. Codes R. & Regs. tit. 11 § 68.0

Current through Register Vol. 46, No. 51, December 18, 2024

Section 68.0 - Preamble

(a) Chapter 892 of the Laws of 1977 provides, as a means of containing the cost of no-fault insurance, for the establishment of schedules of maximum permissible charges for medical, hospital and other professional health services payable under no-fault insurance benefits. Specifically, section 5108 (a) of the Insurance Law provides that the charges for services specified in section 5102 (a)(1) of the Insurance Law, and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss, ". . . shall not exceed the charges permissible under the schedules prepared and established by the chairman of the Workers' Compensation Board for industrial accidents, except as otherwise provided in section thirteen-a of the Workers' Compensation Law."

(b) Paragraph (1) of subdivision (a) of section 5102 of the Insurance Law defines basic economic loss to include necessary expenses incurred for (i) medical, hospital, surgical, nursing, dental, ambulance, X-ray, prescription drug and prosthetic services; (ii) psychiatric, physical and occupational therapy and rehabilitation; (iii) any nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of this State; and (iv) any other professional health services.

(c) Section 5102 (a) of the Insurance Law provides that for the purpose of determining basic economic loss, the expenses incurred under section 5102(a)(1) shall be in accordance with the limitations of section 5108 of the Insurance Law.

(d) The Superintendent of Insurance is required, after consulting with the chairman of the Workers' Compensation Board and the Commissioner of Health, to promulgate rules and regulations implementing and coordinating the Comprehensive Automobile Insurance Reparations Act and the Workers' Compensation Law regarding the charges for other professional health services, including the establishment of schedules for all such services for which schedules have not been prepared and established by the chairman of the Workers' Compensation Board.

(e) The chairman of the Workers' Compensation Board has to date prepared and established fee schedules for medical, chiropractic and podiatric services. These schedules also include fees for some dental, psychiatric and physical therapy services.

(f) Providers of health services are prohibited from demanding or requesting any payment for services in excess of permissible charges, and the law requires insurers to report to the Commissioner of Health patterns of overcharging, excessive treatment or other improper actions by a health provider.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 68.0