Section 3217-D. Grievance procedure and access to specialty care  


Latest version.
  • (a) An
      insurer that issues a comprehensive policy that utilizes  a  network  of
      providers and is not a managed care health insurance contract as defined
      in  subsection  (c)  of  section four thousand eight hundred one of this
      chapter shall establish and maintain a  grievance  procedure  consistent
      with the requirements of section four thousand eight hundred two of this
      chapter.
        (b)  An  insurer  that  issues  a comprehensive policy that utilizes a
      network of providers and is not a managed care health insurance contract
      as defined in subsection (c) of section four thousand eight hundred  one
      of this chapter and requires that specialty care be provided pursuant to
      a  referral  from  a  primary care provider shall provide access to such
      specialty care consistent with the requirements of subsections (b),  (c)
      and  (d)  of  section  four thousand eight hundred four of this chapter;
      provided, however, that nothing in this section shall  be  construed  to
      require  that  an  insurer,  or a primary care provider on behalf of the
      insurer, make a referral to a provider that  is  not  in  the  insurer's
      network.
        (c)  An  insurer  that  issues  a comprehensive policy that utilizes a
      network of providers and is not a managed care health insurance contract
      as defined in subsection (c) of section four thousand eight hundred  one
      of  this  chapter  shall  provide access to transitional care consistent
      with the requirements  of  subsections  (e)  and  (f)  of  section  four
      thousand eight hundred four of this chapter.
        * NB Effective January 1, 2011