On behalf of Licatesi Law Group, LLP on Thursday, January 26, 2012.

Good old Regulation 68, enacted in 1974, in order to ensure that all reasonable and necessary medical treatment following a motor vehicle accident was paid for, which was revised in 2002, is once again up for revision. The original proposed revisions were released in November 2009; subsequently, a second proposed revision released for comment on March 3, 2011. As idealistic as ever, the Insurance Department vows that somehow these revisions will cause less confusion and less fraud.

According to the New York State insurance Department, these revisions come after “an intensive review of the Regulation by the Department’s Office of General Counsel and it’s Property Bureau, including meetings with representatives of insurers, health professionals, trial lawyers, health service providers, and other stakeholders. The aim is to help reduce fraud and abuse associated with no fault claims, while making the no fault system more user-friendly.” User friendly is one way of putting it, but anyone who routinely uses the no fault system knows that proposed regulations will only spawn a plethora of new issues to litigate/arbitrate.

The Insurance Department isn’t shying away from your comments however. They have set up an e-mail, where comments can be directly sent to this address: [email protected] . They also have a web page set up for comments on the revisions: www.ins.state.ny.us/r68/r68_draft_form.htm .

Such issues addressed by the proposed revisions are a reformation of the claims process, combating overbilling and fee overcharging, renovation of the health service exam and exam under oath procedures, and of course to combat fraud.

As a medical provider, please go to https://www.ins.state.ny.us/r68_link.htm and read all the proposed revisions. There are many changes that if put into effect, could impede your ability to be compensated for your services if not followed properly.

One example of a proposed change that could negatively affect providers is the proposed change to the verification process. As of now, providers are not required to respond to a verification request from the insurance carrier in a set period of time; whereas the insurance carrier is required to request said verification in a strictly upheld time period. Now, one of the proposed revisions is to hold providers to respond to a verification request within 90 days, a significant change that providers need to be aware of, as well as comment on.

Be sure to contact well-versed experienced attorneys such as those at Licatesi Law Group, LLP with any questions or concerns regarding Regulation 68 in its current state as well as the proposed revisions. Email: [email protected].

For more information: Call (516) 478-0237
By: Candice L. Deaner, Esq.