April 1998

Choosing A Physician in New York

Obtaining Information About Physician Qualifications
It is not always easy for patients to get the information they may need to pick the physician who is right for them. However, a new law may help. Under an amendment to the New York Public Health Law contained in the New York Managed Care Reform Act, New York Public Health Law section 18-a, physicians and other health care practitioners MUST give patients and prospective patients the following information if it is requested:

• Education, experience, training, specialty and specialty board certification;
• Hospitals with which the physician or other practitioner is affiliated;
• Participation in continuing education programs;
• Whether they are properly licensed;
• Information about any reviews of their clinical performance by the New York State Health Department;

THIS INFORMATION IS AVAILABLE FROM ALL PHYSICIANS INCLUDING PHYSICIANS IN MANAGED CARE PLANS.

If you are referred by your managed care plan to a physician, you still have the right to obtain this information from the physician.

Consumers also have the right to obtain directly from health plans information about the specialty, board certification and hospital affiliations of participating physicians. The right to this information is provided under provisions of the New York Managed Care Reform Act which are contained in New York Public Health Law section 4408  (applicable to HMOs); and New York Insurance Law sections 3217 -a and 4324 (applicable to other types of insurers).

For a patient in an HMO or similar managed care health plan, the information available under the New York Managed Care Reform Act is particularly important because it may let a patient know whether the health plan has a physician in the network who is qualified to treat the patient's illness. REMEMBER, if an HMO does not have an appropriately qualified physician for a patient in the HMO's network, the New York Managed Care Reform Act gives the patient the right to ask the HMO for a referral to an out of network physician at no additional cost beyond what the patient would pay if treated by an in network physician. If you think you need an out of network referral, make sure you ask for it. The referral provisions of the New York Managed Care Reform Act which apply to HMOs are contained in New York Public Health Law section 4403(6) . The referral provisions applicable to other types of health insurance plans are contained in New York Insurance Law section 4804 .  

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