Murphy signed Out-of-Network Healthcare Billing Law in New Jersey

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Murphy signed Out-of-Network Healthcare
BillingLaw in New Jersey
Governor Phil Murphy on August 30th, 2018 signed
a bill that ended the decade-long battle to
address the issue of the cost and impact of
expensive medical bills for residents in the
state. In a statement, Gov. Murphy said, Today,
we are closing the loophole and reigning in
excessive out-of-network costs to prevent
residents from receiving that big surprise in
their mailbox. At the same time, we are making
health care more affordable by ensuring these
costs are not transferred to consumers through
increased health premiums. The bill that was
finally passed this year was sponsored by
Assembly Speaker Craig Coughlin and Sen. Joseph
Vitale (both D-Woodbridge). The Assembly 2039
Bill The Assembly bill 2039, requires hospitals
to disclose to patients, which out-of-network
providers will be billing them before a patient
undergoes procedure or surgery. With the new law
in affect, the Governor said, the state will be
able to rein in the big surprise bills
residents find in their mailboxes after a
hospital stay.
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Murphy signed Out-of-Network Healthcare
BillingLaw in New Jersey
Murphy said, Each year nearly 170,000 New Jersey
citizens get medical bills which they didnt
expect. Bills for services performed,
unbeknownst to them, for professionals outside
the networks. No one likes to be blindsided.
But thats whats been happening to residents who
did not know they were getting out-of-network
medical care until they received a bill in the
mail, Assembly Speaker Craig Coughlin
added. The new bill that turns into a law will
allow for a state-regulated, binding arbitration
process between patients and out-of-network
providers to settle costs of an out-of-network
bill. The state Senate has also amended the
bill to prevent insurance providers from using
pricing benchmarks for services rendered by
out-of-network doctors. Self-Insured Healthcare
Plan A self-insured plan subject to ERISA that
wants to be subject to the act would do so by
filing an annual notice with the state and
amending its plan documents to reflect that the
benefits of the statute apply to the plans
members.
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Murphy signed Out-of-Network Healthcare
BillingLaw in New Jersey

• If a plan opts-in, its members would not be
  balance billed for out-of-network charges for
  emergency care in excess of the deductible,
  copayment, or coinsurance amount applicable to
  in-network services, and the plan can take
  advantage of the acts binding arbitration
  provisions.
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• The opt-in plan must provide each primary insured
  with a health insurance identification card
  indicating that the plan has elected to be
  subject to the act.
• A self-insured plan subject to ERISA that does
  not want to opt in need take no action. If the
  plan does not opt-in, its members may be balance
  billed for out-of-network treatment. If the
  provider and a member do not resolve a payment
  dispute within 30 days after the member has been
  sent a bill, the member or provider may initiate
  binding arbitration to determine payment for the
  services.
• The arbitrators decision will include a final
  binding amount that the arbitrator determines is
  reasonable, and a nonbinding recommendation to
  the self-insured plan of its reasonable
  contribution for payment. Subject to an exception
  for financial hardship, the arbitrators expenses
  and fees are divided equally between the provider
  and the member.
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Murphy signed Out-of-Network Healthcare
BillingLaw in New Jersey
The act takes effect 90 days after enactment
which on or near August 30. Self-insured plans
covering individuals in New Jersey will need to
decide whether to elect to be subject to the act.
We are awaiting regulatory guidance as to many
details, including the opt-in election and the
additional disclosure obligations for covered
self-insured plans. Please feel free to reach
out to us at www.medicalbillerandcoders.com and
contact if you would like to discuss the pros and
cons of opting in or the potential impact of the
act on your health plan or operations.