New Jersey’s Out-of-Network Healthcare Billing Law Goes Into Effect

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.

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