EUO preclusion and EBT’s based upon preserved box #18 defense

Megacure Acupuncture, P.C. v Lancer Ins. Co., 2013 NY Slip Op 51994(U)(App. Term 2d Dept. 2013)

(1) “We note that defendant’s February 13, 2007 letter purporting to delay payment of the claims was not mailed within 15 days of defendant’s receipt of any of these claims and, in any event, is insufficient to toll the 30-day statutory time period within which a claim must be paid or denied (see ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 135, 2011 NY Slip Op 52384 ; Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133, 2010 NY Slip Op 51338 ).

It looks like the EUO provider delay letters were not timely delayed; therefore, the EUO no-show defense was precluded.

(2) “Although the follow-up EUO scheduling letter was sent less than 30 days after the initial request (see Insurance Department Regulations § 65-3.6 ), where, as here, the verification sought is an EUO, a follow-up request is not premature when sent within 10 days after the failure to appear for the initial scheduled examination (see ARCO Med. NY, P.C., 37 Misc 3d 136, 2012 NY Slip Op 52178; ARCO Med., NY, P.C., 34 Misc 3d 135, 2011 NY Slip Op 52384)”

A follow-up request must be sent within 10-days after the failure to appear for the initial examination

(3) “With respect to defendant’s motion to compel plaintiff to produce Tatyana Kapustina, [*3]L.Ac., and Oleg Shargordoskiy for EBTs, a review of the record indicates that defendant preserved its “billing practices” defense by checking box 18 on the NF-10 denial of claim form to assert that plaintiff’s “fees not in accordance with the fee schedule.”

Checked off Box #18 allows the granting of the EBT

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• Second Department’s interpretation of EUO no-show defense requirements
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Legal Update (February 2026): Since this 2013 decision, Insurance Department Regulations § 65-3.6 governing EUO procedures and timing requirements may have been amended, and the specific timeframes for follow-up EUO requests and denial letters discussed in this case should be verified against current regulatory provisions. Practitioners should confirm the current status of the 10-day follow-up rule and 30-day payment/denial requirements under the most recent version of § 65-3.6.