Bills We Support

A 3365-A LAVINE Same as S 5209-A SCARCELLA-SPANTON 

TITLE....Limits the lookback period for insurance overpayment recovery from health care providers to twelve months

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The issue:

New York providers and patients face financial uncertainty because insurers can demand repayment of old claims up to two years later. These clawbacks are usually due to administrative errors by insurance companies not providers. These retroactive clawbacks destabilize small practices, threaten patient access, and create financial uncertainty all without improving fraud prevention.

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S5209-A sets a reasonable 12-month limit for routine recoupments. The bill targets the lookback period used by health plans when they review previously paid claims and seek to recoup money they allege was paid in error.  This is a simple fairness fix that protects providers and patients alike.

There are exceptions where this 12-month limit would not apply, including cases involving suspected fraud, abuse, or misconduct. This bill only prevents insurers from using administrative errors from over 12 months ago to retroactively recoup payments.

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What the bill would do:

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1. Provides financial stability, provider protection and access to care

   1. Practices have reported owing tens of thousands of dollars unexpectedly due to insurance administrative errors. Threatening fiscal integrity of small practices.

   2. Unpredictability of payment can lead to practices refusing to take insurance, limiting access to care.

2. Reduces Administrative Burden

   1. Practices must devote staff time to audits or concede the clawback increasing administrative waste, overhead, and burnout among billing staff and providers.

   2.  S5209-A encourages timely auditing — which is more efficient for both providers and insurers. This lowers administrative costs and lets clinicians focus on patient care.

3. Reduces Risk of Unexpected Patient Billing

   1. Often clawbacks lead to an unexpected shift in coverage leading to patients owing sometimes large amounts of money long after treatment is completed.

   2. A shorter lookback period lowers the risk that a patient’s past care will trigger unexpected cost significantly after care was rendered.

4. Creates fairness and balance in insurer–provider relationships and parity/reciprocity for timely filing

   1. v going back 24 months (timely filing for claims is usually 3- 6 months from date of service).

   2. S5209-A restores fairness by giving both sides timely expectations.

5.  Several states have adopted 12 month lookback windows.

   1. Arizona, California, Missouri, Montana, and Vermont

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Additional Bills:

S9228

HARCKHAM 
Prohibits non-compete agreements for certain medical professionals 
No same as 
SUMM : Add §§191-d & 45, Lab L Prohibits non-compete agreements for certain medical professionals; authorizes covered individuals to bring a civil action in a court of competent jurisdiction against any employer or persons alleged to have violated such prohibition. 
02/18/26 REFERRED TO LABOR
No Same as 

S9230

SCARCELLA-SPANTON 
Provides insurance coverage for perimenopausal and menopausal care and treatment 
No same as 
SUMM : Amd §§3216, 3221 & 4303, Ins L Provides hospital, surgical and medical insurance coverage for perimenopausal and menopausal care and treatment. 
02/18/26 REFERRED TO WOMEN'S ISSUES
No Same as