The NJDPA -- in consultation with our chief counsel, Dan Frier, Esq -- submitted comments to the New Jersey Dept of Banking and Insurance on several new proposed regulations. Below is a brief outline of our comments, with full commentary in the attached document. We hope that this will help bolster network accountability for carriers across the state, and prevent harmful interruptions in patient-care during "in-plan exception" denial appeals.
The New Jersey Neurosurgical Society
New Jersey Doctor Patient Alliance
Download this position paper as a PDF
The State Health Benefits Plan (SHBP) can save hundreds of millions of dollars a year by eliminating hidden fees and commissions paid to insurance companies in their role as Third Party Administrators (TPAs). These savings can be achieved without the devastating public health consequences caused by underpaying doctors and hospitals, pursuant to A-1952/S-1285, while protecting patients from economic hardships and surprise balance billing.
This is an open letter posted in response to a Bamboozled column that appeared in The Star-Ledger on June 5, 2017.
As an orthopaedic hand surgeon and president of the New Jersey Doctor-Patient Alliance, I live and breathe these issues on a daily basis.
I am disheartened in the way this article seems to cast doctors as nefarious agents of the medical community. On the contrary, my colleagues and I take extreme pride in the care we deliver to our patients, as we have devoted the majority of our lives toward helping people at their most vulnerable and stressful moments.
On September 21st, 2016, the Department of Banking and Insurance (DOBI) adopted substantial rule changes regarding OON health care benefits available in the individual (IHC) and small group (SEH) markets. Specifically, NJAC 11:20-24.5 and NJAC 11:21-7.13 were repealed. These regulations, initially adopted in 1993, mandated adequate reimbursements to out-of-network providers, based on the 80th percentile of UCR, for the IHC and SEH markets, respectively.