New Jersey’s Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the Act), codified as NJSA 26:2SS, in now in full effect. The Act, signed by New Jersey Governor Phil Murphy on June 1, 2018, is designed to protect consumers against surprise medical bills from out-of-network providers. Per section 18 of the law, it went into full effect 90 days after enactment.

The law requires healthcare facilities and providers to provide certain disclosures. For example, prior to scheduling a non-emergency appointment, healthcare facilities and providers are required to inform the patient if they are out-of-network, provide expected costs of services upon request, and provide a disclosure of the patient’s financial responsibility related to out-of-network services. For non-emergency procedures, physicians are also required to identify any other provider scheduled for the procedure so the patient can check whether these providers are in-network.

The law also calls for certain procedures for emergency and urgent care services, including not billing a patient in excess of any deductible, copayment, or coinsurance amount if the patient inadvertently received out-of-network emergency or urgent care services. The law also lays out voluntary arbitration procedures for situations where an out-of-network facility and insurance carrier cannot agree on the final offer of reimbursement.

Several states have taken the initiative to address the issue of balance billing. New Mexico’s Office of the Superintendent of Insurance released a study in late 2017 that indicated many patients are surprised by certain medical bills. Earlier this year, insideARM published an article about four other states (Washington, Oregon, New Hampshire, and Virginia) that were reviewing the issue. Since the article was published, the Oregon, New Hampshire, and now the New Jersey measures have been signed into law and are in full effect. These states now join other states that already have either comprehensive or partial protections against balance billing in place.

insideARM Perspective

As laws pertaining to balance billing go into effect, they bring a new set of complexities to the healthcare billing and collection space. While New Jersey's law places the burden on healthcare providers and facilities, it is likely that billing disputes related to this law will trickle down to the collection agency level. Since other states have already enacted similar laws, there is likely some guidance available related to compliance. Balance billing appears to be an issue of interest in many states so similar laws are likely to continue popping up in other parts of the country.


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