New Jersey to Increase Healthcare Transparency and End Surprise Bills

By Deirdre Hartmann, CPA, Partner


Recently, Governor Phil Murphy signed Assembly Bill No. 2039 requiring healthcare facilities and providers to give information to patients on network status before conducting any non-urgent care delivery. The changes coming into effect in the next few months are designed to increase transparency in the healthcare industry and protect consumers from surprise bills of out-of-network health services.


According to the State of New Jersey website, it is estimated that approximately 168,000 of New Jerseyans receive out-of-network bills each year totaling to $420 million. This is due to out-of-network bills being shifted to health insurers, who then pass along their costs to an estimated five million residents who pay up to $956 million more per year more for their commercial insurance premiums.


“No one likes to be blindsided. But that’s what’s been happening to residents who did not know they were getting out-of-network medical care until they received a bill in the mail,” said Assembly Speaker, Craig Coughlin.


The following changes are set to take place as a result of Assembly Bill No. 2039:


Out-of-Network Billing: When conducting services on an “emergency or urgent basis,” the amount that an out-of-network provider will be able to charge the patient in excess of a deductible, copayment of coinsurance will be restricted to the amount applicable to in-network services pursuant to the covered person’s health benefits plan.


Disclose and Transparency: For non-urgent care delivery, it is required that healthcare facilities and professionals provide additional information before performing services on the patient including the in or out-of-network status of the provider and a disclaimer regarding the responsibility of the patient to pay any additional out-of-network fees. Upon patient request, providers must also provide an estimate of fees and publicly post standard charges. Insurance carriers must also provide written notice of changes to their network with detailed information regarding out-of-network services and maintain a phone hotline to address patient questions.


Arbitration: When insurance carriers and providers cannot agree on acceptable reimbursement for services, an arbitrator will be called in to resolve out-of-network billing disputes.


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