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30 November 2015

Proposed NJ Bill Would Eliminate "Surprise Bills"

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A new proposed bill in New Jersey would require healthcare providers to disclose to patients in advance whether their services are covered in-network by the patient's health insurance plan.
United States Food, Drugs, Healthcare, Life Sciences

A new proposed bill in New Jersey would require healthcare providers to disclose to patients in advance whether their services are covered in-network by the patient's health insurance plan. The new bill, similar to recently enacted laws in New York and Connecticut, seeks to eliminate "surprise" medical bills.

Under the proposed New Jersey bill, the successor to a similar effort earlier this year, an insured "will not incur any out-of-pocket costs in excess of the charges applicable to an in-network procedure" unless he or she has "knowingly, voluntarily, and specifically selected an out-of-network provider to provide services." The new bill would further protect consumers by establishing an independent arbitration process to decide billing disputes between health insurers and healthcare providers.

Physicians and hospitals would be required to provide patients with a list of the insurance carriers with which they are in-network, or post the information on their websites. Before scheduling a non-emergency procedure, patients must be informed whether the healthcare provider is out-of-network and what the estimated cost of services is. The provider must also identify any other specialists who will be involved in the patient's care, so that the patient may determine their network status.

The new bill is expected to be passed before the legislative session ends in January.

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