External Appeal in New York; Are Recent Changes Enough?

By Hunter Raines, Albany Government Law Review

New York’s external appeal legislation, giving patients and health care providers a right to an external appeal of health plan adverse coverage determinations, has been invaluable in improving the patient’s access to care while protecting the provider’s right to adequate reimbursement for health care services.  However, changes enacted in July 2011 measurably impact the operation of this statutory creature, which merits examination and review of the process as it currently stands.[1]

In the early 1990s, the rising costs of health care inspired a new insurance model closely tied to the concept of strict care management.[2]  By strictly managing consumer options, health care costs were constrained.[3]  However, this model encumbered access to needed health care for many.[4]  New York’s Managed Care Reform Act, signed by Governor Pataki in 1996, provided new protection for New York consumers in the health insurance market.[5]  Since the passage of the act, consumers now have the right to obtain a description of services and procedures covered by their health plan, the right to an explanation of the patient’s financial responsibility for such procedures and services and the right to appeal adverse coverage determinations.[6]  These legislative protections are far reaching, applying to most health plans excluding those which are self-funded or otherwise subject to ERISA, which is beyond the scope of this article.[7] Continue reading “External Appeal in New York; Are Recent Changes Enough?”

Refusing a Chemical Test by Conduct: The Need For Expansion in Vehicle and Traffic Law § 1194

By Benjamin Fox, Albany Government Law Review

When a police officer is suspicious that someone is driving under the influence it is common knowledge that a field sobriety or breathalyzer test is soon to follow.  It is also well known that the driver will be taken to the local jail for processing should he fail one or both of those tests. However, the administration of a second chemical test while in police custody seems to be less well known.  These tests, typically in the form of another breath test (though blood tests are also possible), are significantly more sophisticated and important than field tests.[1]  The results of the chemical test are admissible in a Vehicle and Traffic Law (VTL) § 1192 hearing – operation of a vehicle while under the influence of alcohol or drugs.[2] Continue reading “Refusing a Chemical Test by Conduct: The Need For Expansion in Vehicle and Traffic Law § 1194”