New York § 608 - 608Payment for independent dispute resolution entity

§ 608. 608Payment for independent dispute resolution entity

§ 608. Payment for independent dispute resolution entity. (a) For disputes involving an insured, when the independent dispute resolution entity determines the health care plan's payment is reasonable, payment for the dispute resolution process shall be the responsibility of the non-participating provider. When the independent dispute resolution entity determines the non-participating provider's fee is reasonable, payment for the dispute resolution process shall be the responsibility of the health care plan. When a good faith negotiation directed by the independent dispute resolution entity pursuant to paragraph four of subsection (a) of section six hundred five of this article, or paragraph six of subsection (a) of section six hundred seven of this article results in a settlement between the health care plan and non-participating provider, the health care plan and the non-participating provider shall evenly divide and share the prorated cost for dispute resolution. * (b) For disputes involving a patient that is not an insured, when the independent dispute resolution entity determines the physician's fee is reasonable, payment for the dispute resolution process shall be the responsibility of the patient unless payment for the dispute resolution process would pose a hardship to the patient. The superintendent shall promulgate a regulation to determine payment for the dispute resolution process in cases of hardship. When the independent dispute resolution entity determines the physician's fee is unreasonable, payment for the dispute resolution process shall be the responsibility of the physician. * NB Effective until August 26, 2026 * (b) (1) A non-participating provider and a health care plan shall submit full payment for the dispute resolution process upon submission of the dispute resolution application or, if the responding party, when responding to the independent dispute resolution entity's request for eligibility information and supporting documents. (2) An independent dispute resolution entity shall not comingle the payments for the dispute resolution process with any other funds held by the entity and shall hold all payments in a separate account. (3) An independent dispute resolution entity shall issue a refund of the dispute resolution process payment to the prevailing party within thirty days of rendering a determination on the dispute or rejecting the dispute as ineligible. * NB Effective August 26, 2026 * (c) For disputes involving a patient that is not an insured, when the independent dispute resolution entity determines the physician's fee is reasonable, payment for the dispute resolution process shall be the responsibility of the patient unless payment for the dispute resolution process would pose a hardship to the patient. The superintendent shall promulgate a regulation to determine payment for the dispute resolution process in cases of hardship. When the independent dispute resolution entity determines the physician's fee is unreasonable, payment for the dispute resolution process shall be the responsibility of the physician. * NB Effective August 26, 2026