(REPRINTED WITH ADOPTED AMENDMENTS)

 

Assembly Bill No. 36–Assemblyman Neighbors

 

Prefiled January 24, 2001

 

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Revises various provisions governing approval and payment of claims. (BDR 57‑460)

 

FISCAL NOTE:            Effect on Local Government: No.

                                    Effect on the State: No.

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to insurance; revising various provisions governing the approval and payment of claims; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

1-1    Section 1. NRS 683A.0879 is hereby amended to read as follows:

1-2    683A.0879  1.  Except as otherwise provided in subsection 2, an

1-3  administrator shall approve or deny a claim relating to health insurance

1-4  coverage within 30 calendar days after the administrator receives the

1-5  claim. If the claim is approved, the administrator shall pay the claim within

1-6  30 calendar days after it is approved. If the approved claim is not paid

1-7  within that period, the administrator shall pay interest on the claim at the

1-8  rate of interest established pursuant to NRS 99.040 . [unless a different rate

1-9  of interest is established pursuant to an express written contract between

1-10  the administrator and the provider of health care.] The interest must be

1-11  calculated from 30 calendar days after the date on which the claim is

1-12  approved until the claim is paid.

1-13    2.  If the administrator requires additional information to determine

1-14  whether to approve or deny the claim, he shall notify the claimant of his

1-15  request for the additional information within 20 calendar days after he

1-16  receives the claim. The administrator shall notify the provider of health

1-17  care of all the specific reasons for the delay in approving or denying the

1-18  claim. If additional information is requested from the provider of health

1-19  care, the provider shall furnish the additional information within 20

1-20  calendar days after receiving the request. If the provider of health care

1-21  fails to furnish the additional information within that period, the

1-22  provider is not entitled to any interest payment to which he would

2-1  otherwise be entitled for the late payment of a claim. The administrator

2-2  shall approve or deny the claim within [30] 20 calendar days after

2-3  receiving the additional information. If the claim is approved, the

2-4  administrator shall pay the claim within [30] 20 calendar days after he

2-5  receives the additional information. If the approved claim is not paid within

2-6  that period, the administrator shall pay interest on the claim in the manner

2-7  prescribed in subsection 1[.] , except that the interest must be calculated

2-8  from 20 calendar days after the date on which the additional information

2-9  is received until the claim is paid.

2-10    3.  An administrator shall not request a claimant to resubmit

2-11  information that the claimant has already provided to the administrator,

2-12  unless the administrator provides a legitimate reason for the request and the

2-13  purpose of the request is not to delay the payment of the claim, harass the

2-14  claimant or discourage the filing of claims.

2-15    4.  An administrator shall not pay only part of a claim that has been

2-16  approved and is fully payable.

2-17    5.  A court shall award costs and reasonable attorney’s fees to the

2-18  prevailing party in an action brought pursuant to this section.

2-19    Sec. 2.  NRS 689A.410 is hereby amended to read as follows:

2-20    689A.410  1.  Except as otherwise provided in subsection 2, an insurer

2-21  shall approve or deny a claim relating to a policy of health insurance within

2-22  30 calendar days after the insurer receives the claim. If the claim is

2-23  approved, the insurer shall pay the claim within 30 calendar days after it is

2-24  approved. If the approved claim is not paid within that period, the insurer

2-25  shall pay interest on the claim at the rate of interest established pursuant to

2-26  NRS 99.040 . [unless a different rate of interest is established pursuant to

2-27  an express written contract between the insurer and the provider of health

2-28  care.] The interest must be calculated from 30 calendar days after the date

2-29  on which the claim is approved until the claim is paid.

2-30    2.  If the insurer requires additional information to determine whether

2-31  to approve or deny the claim, it shall notify the claimant of its request for

2-32  the additional information within 20 calendar days after it receives the

2-33  claim. The insurer shall notify the provider of health care of all the specific

2-34  reasons for the delay in approving or denying the claim. If additional

2-35  information is requested from the provider of health care, the provider

2-36  shall furnish the additional information within 20 calendar days after

2-37  receiving the request. If the provider of health care fails to furnish the

2-38  additional information within that period, the provider is not entitled to

2-39  any interest payment to which he would otherwise be entitled for the late

2-40  payment of a claim. The insurer shall approve or deny the claim within

2-41  [30] 20 calendar days after receiving the additional information. If the

2-42  claim is approved, the insurer shall pay the claim within [30] 20 calendar

2-43  days after it receives the additional information. If the approved claim is

2-44  not paid within that period, the insurer shall pay interest on the claim in the

2-45  manner prescribed in subsection 1[.] , except that the interest must be

2-46  calculated from 20 calendar days after the date on which the additional

2-47  information is received until the claim is paid.

2-48    3.  An insurer shall not request a claimant to resubmit information that

2-49  the claimant has already provided to the insurer, unless the insurer provides

3-1  a legitimate reason for the request and the purpose of the request is not to

3-2  delay the payment of the claim, harass the claimant or discourage the filing

3-3  of claims.

3-4    4.  An insurer shall not pay only part of a claim that has been approved

3-5  and is fully payable.

3-6    5.  A court shall award costs and reasonable attorney’s fees to the

3-7  prevailing party in an action brought pursuant to this section.

3-8    Sec. 3.  NRS 689B.255 is hereby amended to read as follows:

3-9    689B.255  1.  Except as otherwise provided in subsection 2, an insurer

3-10  shall approve or deny a claim relating to a policy of group health insurance

3-11  or blanket insurance within 30 calendar days after the insurer receives the

3-12  claim. If the claim is approved, the insurer shall pay the claim within 30

3-13  calendar days after it is approved. If the approved claim is not paid within

3-14  that period, the insurer shall pay interest on the claim at the rate of interest

3-15  established pursuant to NRS 99.040 . [unless a different rate of interest is

3-16  established pursuant to an express written contract between the insurer and

3-17  the provider of health care.] The interest must be calculated from 30

3-18  calendar days after the date on which the claim is approved until the claim

3-19  is paid.

3-20    2.  If the insurer requires additional information to determine whether

3-21  to approve or deny the claim, it shall notify the claimant of its request for

3-22  the additional information within 20 calendar days after it receives the

3-23  claim. The insurer shall notify the provider of health care of all the specific

3-24  reasons for the delay in approving or denying the claim. If additional

3-25  information is requested from the provider of health care, the provider

3-26  shall furnish the additional information within 20 calendar days after

3-27  receiving the request. If the provider of health care fails to furnish the

3-28  additional information within that period, the provider is not entitled to

3-29  any interest payment to which he would otherwise be entitled for the late

3-30  payment of a claim. The insurer shall approve or deny the claim within

3-31  [30] 20 calendar days after receiving the additional information. If the

3-32  claim is approved, the insurer shall pay the claim within [30] 20 calendar

3-33  days after it receives the additional information. If the approved claim is

3-34  not paid within that period, the insurer shall pay interest on the claim in the

3-35  manner prescribed in subsection 1[.] , except that the interest must be

3-36  calculated from 20 calendar days after the date on which the additional

3-37  information is received until the claim is paid.

3-38    3.  An insurer shall not request a claimant to resubmit information that

3-39  the claimant has already provided to the insurer, unless the insurer provides

3-40  a legitimate reason for the request and the purpose of the request in not to

3-41  delay the payment of the claim, harass the claimant or discourage the filing

3-42  of claims.

3-43    4.  An insurer shall not pay only part of a claim that has been approved

3-44  and is fully payable.

3-45    5.  A court shall award costs and reasonable attorney’s fees to the

3-46  prevailing party in an action brought pursuant to this section.

3-47    Sec. 4.  NRS 689C.485 is hereby amended to read as follows:

3-48    689C.485  1.  Except as otherwise provided in subsection 2, a carrier

3-49  serving small employers and a carrier that offers a contract to a voluntary

4-1  purchasing group shall approve or deny a claim relating to a policy of

4-2  health insurance within 30 calendar days after the carrier receives the

4-3  claim. If the claim is approved, the carrier shall pay the claim within 30

4-4  calendar days after it is approved. If the approved claim is not paid within

4-5  that period, the carrier shall pay interest on the claim at the rate of interest

4-6  established pursuant to NRS 99.040 . [unless a different rate of interest is

4-7  established pursuant to an express written contract between the carrier and

4-8  the provider of health care.] The interest must be calculated from 30

4-9  calendar days after the date on which the claim is approved until the claim

4-10  is paid.

4-11    2.  If the carrier requires additional information to determine whether to

4-12  approve or deny the claim, it shall notify the claimant of its request for the

4-13  additional information within 20 calendar days after it receives the claim.

4-14  The carrier shall notify the provider of health care of all the specific

4-15  reasons for the delay in approving or denying the claim. If additional

4-16  information is requested from the provider of health care, the provider

4-17  shall furnish the additional information within 20 calendar days after

4-18  receiving the request. If the provider of health care fails to furnish the

4-19  additional information within that period, the provider is not entitled to

4-20  any interest payment to which he would otherwise be entitled for the late

4-21  payment of a claim. The carrier shall approve or deny the claim within

4-22  [30] 20 calendar days after receiving the additional information. If the

4-23  claim is approved, the carrier shall pay the claim within [30] 20 calendar

4-24  days after it receives the additional information. If the approved claim is

4-25  not paid within that period, the carrier shall pay interest on the claim in the

4-26  manner prescribed in subsection 1[.] , except that the interest must be

4-27  calculated from 20 calendar days after the date on which the additional

4-28  information is received until the claim is paid.

4-29    3.  A carrier shall not request a claimant to resubmit information that

4-30  the claimant has already provided to the carrier, unless the carrier provides

4-31  a legitimate reason for the request and the purpose of the request is not to

4-32  delay the payment of the claim, harass the claimant or discourage the filing

4-33  of claims.

4-34    4.  A carrier shall not pay only part of a claim that has been approved

4-35  and is fully payable.

4-36    5.  A court shall award costs and reasonable attorney’s fees to the

4-37  prevailing party in an action brought pursuant to this section.

4-38    Sec. 5.  NRS 695A.188 is hereby amended to read as follows:

4-39    695A.188  1.  Except as otherwise provided in subsection 2, a society

4-40  shall approve or deny a claim relating to a certificate of health insurance

4-41  within 30 calendar days after the society receives the claim. If the claim is

4-42  approved, the society shall pay the claim within 30 calendar days after it is

4-43  approved. If the approved claim is not paid within that period, the society

4-44  shall pay interest on the claim at the rate of interest established pursuant to

4-45  NRS 99.040 . [unless a different rate of interest is established pursuant to

4-46  an express written contract between the society and the provider of health

4-47  care.] The interest must be calculated from 30 calendar days after the date

4-48  on which the claim is approved until the claim is paid.

5-1    2.  If the society requires additional information to determine whether

5-2  to approve or deny the claim,it shall notify the claimant of its request for

5-3  the additional information within 20 calendar days after it receives the

5-4  claim. The society shall notify the provider of health care of all the specific

5-5  reasons for the delay in approving or denying the claim. If additional

5-6  information is requested from the provider of health care, the provider

5-7  shall furnish the additional information within 20 calendar days after

5-8  receiving the request. If the provider of health care fails to furnish the

5-9  additional information within that period, the provider is not entitled to

5-10  any interest payment to which he would otherwise be entitled for the late

5-11  payment of a claim. The society shall approve or deny the claim within

5-12  [30] 20 calendar days after receiving the additional information. If the

5-13  claim is approved, the society shall pay the claim within [30] 20 calendar

5-14  days after it receives the additional information. If the approved claim is

5-15  not paid within that period, the society shall pay interest on the claim in the

5-16  manner prescribed in subsection 1[.] , except that the interest must be

5-17  calculated from 20 calendar days after the date on which the additional

5-18  information is received until the claim is paid.

5-19    3.  A society shall not request a claimant to resubmit information that

5-20  the claimant has already provided to the society, unless the society

5-21  provides a legitimate reason for the request and the purpose of the request

5-22  is not to delay the payment of the claim, harass the claimant or discourage

5-23  the filing of claims.

5-24    4.  A society shall not pay only part of a claim that has been approved

5-25  and is fully payable.

5-26    5.  A court shall award costs and reasonable attorney’s fees to the

5-27  prevailing party in an action brought pursuant to this section.

5-28    Sec. 6.  NRS 695B.2505 is hereby amended to read as follows:

5-29    695B.2505  1.  Except as otherwise provided in subsection 2, a

5-30  corporation subject to the provisions of this chapter shall approve or deny a

5-31  claim relating to a contract for dental, hospital or medical services within

5-32  30 calendar days after the corporation receives the claim. If the claim is

5-33  approved, the corporation shall pay the claim within 30 calendar days after

5-34  it is approved. If the approved claim is not paid within that period, the

5-35  corporation shall pay interest on the claim at the rate of interest established

5-36  pursuant to NRS 99.040 . [unless a different rate of interest is established

5-37  pursuant to an express written contract between the corporation and the

5-38  provider of health care.] The interest must be calculated from 30 calendar

5-39  days after the date on which the claim is approved until the claim is paid.

5-40    2.  If the corporation requires additional information to determine

5-41  whether to approve or deny the claim, it shall notify the claimant of its

5-42  request for the additional information within 20 calendar days after it

5-43  receives the claim. The corporation shall notify the provider of dental,

5-44  hospital or medical services of all the specific reasons for the delay in

5-45  approving or denying the claim. If additional information is requested

5-46  from the provider of dental, hospital or medical services, the provider

5-47  shall furnish the additional information within 20 calendar days after

5-48  receiving the request. If the provider of dental, hospital or medical

5-49  services fails to furnish the additional information within that period, the

6-1  provider is not entitled to any interest payment to which he would

6-2  otherwise be entitled for the late payment of a claim. The corporation

6-3  shall approve or deny the claim within [30] 20 calendar days after

6-4  receiving the additional information. If the claim is approved, the

6-5  corporation shall pay the claim within [30] 20 calendar days after it

6-6  receives the additional information. If the approved claim is not paid within

6-7  that period, the corporation shall pay interest on the claim in the manner

6-8  prescribed in subsection 1[.] , except that the interest must be calculated

6-9  from 20 calendar days after the date on which the additional information

6-10  is received until the claim is paid.

6-11    3.  A corporation shall not request a claimant to resubmit information

6-12  that the claimant has already provided to the corporation, unless the

6-13  corporation provides a legitimate reason for the request and the purpose of

6-14  the request is not to delay the payment of the claim, harass the claimant or

6-15  discourage the filing of claims.

6-16    4.  A corporation shall not pay only part of a claim that has been

6-17  approved and is fully payable.

6-18    5.  A court shall award costs and reasonable attorney’s fees to the

6-19  prevailing party in an action brought pursuant to this section.

6-20    Sec. 7.  NRS 695C.185 is hereby amended to read as follows:

6-21    695C.185  1.  Except as otherwise provided in subsection 2, a health

6-22  maintenance organization shall approve or deny a claim relating to a health

6-23  care plan within 30 calendar days after the health maintenance

6-24  organization receives the claim. If the claim is approved, the health

6-25  maintenance organization shall pay the claim within 30 calendar days after

6-26  it is approved. If the approved claim is not paid within that period, the

6-27  health maintenance organization shall pay interest on the claim at the rate

6-28  of interest established pursuant to NRS 99.040 . [unless a different rate of

6-29  interest is established pursuant to an express written contract between the

6-30  corporation and the provider of health care.] The interest must be

6-31  calculated from 30 calendar days after the date on which the claim is

6-32  approved until the claim is paid.

6-33    2.  If the health maintenance organization requires additional

6-34  information to determine whether to approve or deny the claim, it shall

6-35  notify the claimant of its request for the additional information within 20

6-36  calendar days after it receives the claim. The health maintenance

6-37  organization shall notify the provider of health care services of all the

6-38  specific reasons for the delay in approving or denying the claim. If

6-39  additional information is requested from the provider of health care

6-40  services, the provider shall furnish the additional information within 20

6-41  calendar days after receiving the request. If the provider of health care

6-42  services fails to furnish the additional information within that period, the

6-43  provider is not entitled to any interest payment to which he would

6-44  otherwise be entitled for the late payment of a claim. The health

6-45  maintenance organization shall approve or deny the claim within [30] 20

6-46  calendar days after receiving the additional information. If the claim is

6-47  approved, the health maintenance organization shall pay the claim within

6-48  [30] 20 calendar days after it receives the additional information. If the

6-49  approved claim is not paid within that period, the health maintenance

7-1  organization shall pay interest on the claim in the manner prescribed in

7-2  subsection 1[.] , except that the interest must be calculated from 20

7-3  calendar days after the date on which the additional information is

7-4  received until the claim is paid.

7-5    3.  A health maintenance organization shall not request a claimant to

7-6  resubmit information that the claimant has already provided to the health

7-7  maintenance organization, unless the health maintenance organization

7-8  provides a legitimate reason for the request and the purpose of the request

7-9  is not to delay the payment of the claim, harass the claimant or discourage

7-10  the filing of claims.

7-11    4.  A health maintenance organization shall not pay only part of a claim

7-12  that has been approved and is fully payable.

7-13    5.  A court shall award costs and reasonable attorney’s fees to the

7-14  prevailing party in an action brought pursuant to this section.

7-15    Sec. 8.  The amendatory provisions of this act apply only to contracts

7-16  entered into, amended, extended or renewed after the effective date of this

7-17  act.

7-18    Sec. 9.  This act becomes effective upon passage and approval.

 

7-19  H