Legislation


A 547 – New Jersey

Status: Inactive / Dead
Year Introduced: 2020
Link: https://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=A547

“Health Care Consumer’s Out-of-Network Protection, Transparency, Cost Containment and Accountability Act.” This bill is intended to provide remedies for individuals who are treated by physicians and treated in facilities that do not belong to a provider network used by the individual’s health benefits plan and who are consequently billed for the balance of charges that are not paid for by their health benefits plan. In order to provide such services and to provide transparency in the health care system, the bill requires that at the time a non-emergency medical procedure or other health care service is scheduled for a covered person, a physician must disclose to the patient whether or not he is a participating physician in the health benefits plan in which the covered person is a member. If the physician is a non-participating physician, the covered person will have the option of either finding an alternative physician or selecting the non-participating physician. If the patient knowingly selects a non-participating physician, the physician would be required to provide a written estimate of the probable cost of the procedure or service, not including unforeseen medical circumstances that may arise when the procedure or service is provided. The non-participating physician must secure the written assent of the patient to pay any balance that is in excess of the amount paid by the person’s health benefits plan. The covered person must be informed that he will have a financial responsibility with respect to the services that are provided. The physician also has to provide the covered person with information regarding any other physician or group of physicians whose ancillary services are to be utilized by the attending physician, as well as information as to how the patient can determine whether the ancillary physician or physicians are in the patient’s network, thus avoiding what has been called “surprise” balance billing. The same requirements would apply to hospitals, which would have to inform patients that their facility-based physicians, including staff physicians, radiologists, and anesthesiologists who bill separately, may not be in the patient’s health benefits plan network.


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