Section 5108. Limit on charges by providers of health services  


Latest version.
  • (a) The
      charges for services specified in paragraph one  of  subsection  (a)  of
      section  five  thousand  one hundred two of this article 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
      where the insurer or arbitrator determines that  unusual  procedures  or
      unique circumstances justify the excess charge.
        (b)  The  superintendent,  after  consulting  with the chairman of the
      workers' compensation  board  and  the  commissioner  of  health,  shall
      promulgate  rules  and  regulations  implementing  and  coordinating the
      provisions of this  article  and  the  workers'  compensation  law  with
      respect  to  charges  for  the professional health services specified in
      paragraph one of subsection (a) of section five thousand one hundred two
      of this article, 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.
        (c) No provider of health  services  specified  in  paragraph  one  of
      subsection  (a) of section five thousand one hundred two of this article
      may demand or request any payment in addition to the charges  authorized
      pursuant to this section. Every insurer shall report to the commissioner
      of  health  any  patterns  of overcharging, excessive treatment or other
      improper actions by a health provider  within  thirty  days  after  such
      insurer has knowledge of such pattern.