Sunday, June 21, 2009

Providers Relationships

- “The Insurance Department regulations provide, in relevant part, for the direct payment of benefits “directly to the applicant … or, upon assignment by the applicant… [to] the providers of services” (11 NYCRR §65.15[j][1]). Pursuant to these regulations Plaintiff would be entitled to payment from the defendant as assignee only if it was the provider of the service billed for. If the treating provider was an employee of a billing provider, the billing provider would be considered a provider of services, thought its employee, and thereby entitled under the regulation to direct payment. If, however, the treating provider was an independent contractor, the billing provider would not be entitled to direct payment under the regulation since it did not provide service to the applicant patient.” Rockaway Blvd. Med. P.C. v. Progressive Ins. 2004 NYSlipOp 24184

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