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Tony Bawidamann – Vice President, Government Affairs

June 1, 2018, Governor Murphy signed P.L. 2018 C.32 “Out of Network Consumer Protection, Transparency, Cost Containment and Accountability Act” which became effective on August 20, 2018. This law helps to protect patients from out-of-network bills, which result in substantial costs for consumers and for businesses. The regulations for this law are still being written by the Department of Banking and Insurance (“DOBI”) and are expected to be published sometime this summer.

Under this law, healthcare facilities, healthcare professionals, physicians and insurance carriers must follow disclosure requirements to patients regarding out-of-network status. The law must follow disclosure requirements to patients regarding out of network status. The law also sets limits on balance billing for inadvertent or emergency services by provided by an out of network provider, and establishes an arbitration system to resolve billing disputes.

This past week the Senate Commerce Committee heard testimony from Department of Banking and Insurance Commissioner Marlene Caride, hospitals, providers and other interested parties. Most who testified were concerned with the arbitration system formed by the state’s new out-of-network law to handle disputes between health insurers and providers. Close to 1,100 cases have gone through the arbitration process since the end of August. Commissioner Caride addressed this issue by acknowledging that both sides have concerns but thinks it’s too early to say the law needs to be amended.

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