Legislation


S 3458 – New Jersey

Status: Inactive / Dead
Year Introduced: 2021
Link: https://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=S3458

Revises out-of-network arbitration process. This bill amends the “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” to revise certain aspects of the arbitration processes established in that act for claims involving health insurance carriers subject to the provisions of the act. The bill extends the amount of time that the insurance carrier and healthcare provider have to negotiate a settlement in the event of an inadvertent use of out-of-network services from 30 to 60 days, and extends the deadline for the carrier, provider, or covered person to initiate binding arbitration in the event of a failure to reach a settlement from within 30 days of the final offer to within 180 days of the final offer. The bill deletes a requirement that the difference between a carrier’s and provider’s final offers be $1,000 or higher in order for binding arbitration to be initiated. The bill changes the certification requirement for arbitrators from a certification from the American Arbitration Association to a certification from the Department of Banking and Insurance. Finally, the bill requires that an arbitrator’s decision be based on a standard of being usual, reasonable, and customary, based on the provider’s usual and customary fees, explanations of benefits, and the reasonable fees of other providers in the relevant region. The fee shall be one of the two amounts submitted by the parties. If this determination requires the use of a database, the database shall be identified, and have its edition date, geozip, and percentile included.


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