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Assignment of Benefits, Part 7: New York

More and more requests are coming in from our readers, and this in this post we are looking at Assignments of Benefits (“AOBs”) in New York.

New York follows the majority of states we have reviewed and permits AOBs when the assignment takes place post-loss. “Upon the occurrence of a loss the claim of the assured is a right to payment—a mere chose in action which may be assigned the same as any other chose in action.” 1 Additionally, the AOB is valid despite anti-assignment clauses: “The assignment of a fire insurance policy subsequent to loss is valid regardless of the condition of the policy.” 2

New York has even codified their acceptance of AOBs. N.Y. Gen. Oblig. Law § 13–101 – Transfer of Claims , states:

Any claim or demand can be transferred, except in one of the following cases: Where it is to recover damages for a personal injury; Where it is founded upon a grant, which is made void by a statute of the state; or upon a claim to or interest in real property, a grant of which, by the transferrer, would be void by such a statute; Where a transfer thereof is expressly forbidden by: (a) a statute of the state, or (b) a statute of the United States, or (c) would contravene public policy.

Additionally, “the owner of the claim need not use a particular form of assignment,” 3 however, “the assignor must ‘manifest an intention to make the assignee the owner of the claim.’” 4 Further, New York also permits AOBs to be made orally:

[U]nder New York law an assignment may even be made orally, see Krauss v. Cent. Ins. Co. of Balt. , 40 N.Y.S.2d 736, 741 (Sup.Ct.1943) (“[A]n assignment of a chose in action other than a negotiable instrument may be by parol.”), though assignments lacking consideration must be signed and in writing, see N.Y. Gen. Oblig. Law § 5–1107 . 5

If you have any specific questions on AOBs or would like to see your state come up sooner, please comment below, or send me an email at [email protected].

As always, I’ll leave you with a (mildly) related tune, here’s New York’s own Velvet Underground with their hit—and one of my personal favorites— Sunday Morning :

https://www.youtube.com/watch?v=3qK82JvRY5s

_____________________ 1 Krauss v. Central Ins. Co. of Baltimore , 40 N.Y.S.2d 736, 741 (Sup.Ct. 1943). 2 Id. , citing Courtney v. New York City Ins. Co. , 28 Barb. 116 (1858). 3 Digizip.com v. Verizon Services Corp. , 2015 WL 1283676 at 3 (S.D.N.Y. 2015) . 4 Id. , citing Advanced Magnetics, Inc. v. Bayfront Partners, Inc., 106 F.3d 11, 17 (2d Cir.1997) . 5 Id.

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What Is Form DOH-4316?

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Form DOH-4316 Assignment of Benefits - New York

• United States Legal Forms
• New York Legal Forms
• New York State Department of Health

This is a legal form that was released by the New York State Department of Health - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Q: What is Form DOH-4316? A: Form DOH-4316 is the Assignment of Benefits form in New York.

Q: What is the purpose of Form DOH-4316? A: The purpose of Form DOH-4316 is to allow a healthcare provider to bill and receive payment directly from an insurance company on behalf of a patient.

Q: Who needs to fill out Form DOH-4316? A: The healthcare provider needs to fill out Form DOH-4316.

Q: Is Form DOH-4316 specific to New York? A: Yes, Form DOH-4316 is specific to New York.

Form Details:

• Released on October 1, 2011;
• The latest edition provided by the New York State Department of Health;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application .

Download a printable version of Form DOH-4316 by clicking the link below or browse more documents and templates provided by the New York State Department of Health.

Download Form DOH-4316 Assignment of Benefits - New York

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Information for members of New York Insurance Plans: Emergency Services and Surprise Bills

What is a surprise bill.

A surprise bill is a bill you receive for covered services performed by a non-participating (out-of-network) health care provider in the following circumstances:

• The out-of-network provider performs services at a participating (network) hospital or ambulatory surgery center and:
• A network doctor is not available at the time the health care service was performed; or
• An out-of-network provider performs services without your knowledge.
• A network provider refers you to an out-of-network provider without your written consent. If your plan does not require referrals, a surprise bill only occurs in limited circumstances. For example, when during your office visit a network doctor brings in an out-of-network provider or sends bloodwork to an out-of-network laboratory without your written consent.
• You receive out-of-network (OON) emergency hospital services, including inpatient services following an emergency room visit.

A surprise bill does not include a bill for health care services when you choose to see an out-of-network provider.

What is an out-of-network provider?

An out-of-network provider is a doctor, health care professional, or facility (like a hospital or ambulatory surgery center) who isn’t part of your plan network. You may pay more for services you get from out-of-network providers.

What happens when I use an out-of-network provider?

Your costs may be higher. A facility must inform you if any out-of-network providers will be involved in your care. If you are not informed, you will only be responsible to pay your in-network deductible, co-pay or co-insurance amount. A surprise bill does not include a bill for health care services when you agree to see an out-of-network provider.

If I go to a network hospital will all of the providers be in the network?

Maybe. Sometimes specialists like emergency room doctors, anesthesiologists, radiologists or pathologists are not part of your network. For example, if you go to a network hospital and get an X-ray, the doctor reading the X-ray may not be in the network.

How do I make sure I receive care from a network provider?

When receiving care, please make sure to ask that all services you receive are from network providers. You should also confirm that any new doctor or health care provider is in the network for your plan.

To find a network provider:

• Log into myuhc.com ® and select Find a Provider; or
• Call us at the phone number on your health plan ID card, and we’ll be happy to help.

What if I have an emergency?

You should go to the nearest emergency room for treatment.

How much will I be responsible to pay for emergency and surprise bills?

For either a surprise bill or emergency services, you will only be responsible to pay your in-network deductible, co-pay or co-insurance amount. We may initially pay the claim at the out-of-network level until further information is provided.

What should I do if I get a surprise bill or a bill for emergency services?

If you receive a bill from an out-of-network provider and believe it is a surprise bill or a bill for emergency services, do not pay the provider. Call the phone number on your health plan ID card. We may request that you submit additional information needed to determine whether it is a surprise bill. If you receive a surprise bill, you will need to fill out and submit the New York State Out-of-Network Surprise Medical Bill Assignment of Benefits Form.  The form and instructions are available at https://dfs.ny.gov/search/site?search=assignment+of+benefits+form . 

We may attempt to negotiate with the provider or pay an additional amount to resolve the claim. If we pay more, your cost share may increase.

Where should I send the New York Assignment of Benefits form?

Please send the completed New York Assignment of Benefits form and a copy of the bill to UnitedHealthcare at the address listed on your health plan ID card, or submit electronically at https://nyrmo.optummessenger.com/public/opensubmit .

What if the provider disagrees with the amount paid?

If the provider disagrees, the provider may submit the dispute for review through New York’s independent dispute resolution process. After the dispute is resolved, your cost share may increase if the health plan is told they must pay additional amounts.

What is the independent dispute resolution process?

New York will select an independent dispute resolution entity (IDRE) to review claims for emergency services and surprise bills where the payment amount can’t be agreed upon. The IDRE will receive information about the services received and determine the reasonable fee for the services. The IDRE will issue a decision accepting either our payment amount or the provider’s billed charge. For surprise bills, a dispute may be submitted to the IDRE for review by a health care plan, an out-of-network physician, an out-of-network referred health care provider, or an insured who does not assign benefits by completing the NY AOB form. To submit a dispute to the IDRE, complete the application found at NYS IDR Provider and Insurer Application .

If you have questions, please call the member phone number on your health plan ID card.