NJDPA Comments on DOBI regulations

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. Continue reading

Insurance Industry ERISA Violations and Rising Health Care Costs in New Jersey

POSITION PAPER The New Jersey Neurosurgical Society New Jersey Doctor Patient Alliance Download this position paper as a PDF Executive Summary 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. Continue reading

Bamboozled: A doctor's perspective

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. Continue reading

Update, Summary, and Position Paper – DOBI/SEH/IHC rule changes affecting voluntary Out-of-Network reimbursement

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  Specifically, NJAC 11:20-24.5 and NJAC 11:21-7.13 were repealed.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. Continue reading

How Self-dealing Insurance Companies Game Unions and their Members

Many private corporations, unions, and local municipalities provide health insurance to their workers through a process known as self-funding. In this arrangement, when a worker needs to see a doctor, get a test, or take a medicine, it is the employer or union who foots the bill – not a health insurance company. So where does the insurance company fit in? Continue reading

You may have lost access to your New Jersey doctor as of January 1, 2017

A recent, little-known New Jersey government ruling has allowed your insurance company to effectively take away your out-of-network benefits as of January 1, 2017. In 2016, the New Jersey Small Employer Health Board of the Department of Banking and Insurance (DOBI), a group comprised mostly of insurance representatives, made up a rule that allows your insurance company to limit the amount of money they reimburse your out-of-network doctor. Continue reading