(1) review the activities of the health care plans and external appeal
agents pursuant to this title, including the extent to which such plans
and agents adhere to the standards and time frames required pursuant to
this title;
(2) investigate complaints by insureds regarding requests for and
processing of external appeals; and
(3) conduct random audits of health care plans and external appeal
agents to determine compliance with the provisions of this title.
(b) Each health care plan and external appeal agent shall annually, in
such form as the superintendent shall require, report the number of
external appeals requested by insureds and the outcomes of any such
external appeals.
(c) The superintendent shall annually report, by plan and by agent,
such information to the governor and the legislature, provided that no
such information shall be included which would otherwise be deemed
confidential information within the meaning of this chapter.
Structure New York Laws
Article 49 - Utilization Review and External Appeal
Title 2 - Right to External Appeal
4910 - Right to External Appeal Established.
4911 - Powers of the Superintendent.
4912 - Standards for Certification.
4914 - Procedures for External Appeals of Adverse Determinations.
4916 - Oversight and Surveillance of the External Appeal Process.