| Definition |
Complaints to the State of New York about health insurers', including prompt-pay complaints. |
Complaints about the timely processing of a claim. |
A request to a health insurer to reconsider its decision to deny coverage of a medical service
that it considers experimental, investigational, not medically necessary or for HMO members, an out-of-network service.
|
An independent, third-party review of a health insurer's denial of a service considered
experimental, investigational, not medically necessary or for HMO members, out-of-network service.
|
A complaint to an HMO about denial of coverage based on limitations or exclusions in the contract.
|
| Filed by |
Consumers, their designee or providers. |
Consumers, their designee or providers. |
Consumers or their authorized representative, which may be the provider. The provider can file on
their own behalf for services already provided.
|
Consumers or their authorized representative, which may be the provider. The provider can file on
their own behalf for services already provided.
|
Consumers or their designee. |