Founder Discusses Need to Start NJDPA

Dr. Peter DeNoble, the president of the New Jersey Doctor Patient Alliance, sat down for an entertaining conversation on what lead him into the medical field, how he met his wife, and why he felt the need to start the New Jersey Doctor-Patient Alliance, a nonprofit organization that unites patients and their doctors in a mission to promote access to quality, affordable health care in New Jersey.

DOBI seeks feedback on Out-of-Network Regulations

The Department of Banking and Insurance (“Department”) intends to propose regulations to implement the Out-Of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, P.L. 2018, c. 32 (N.J.S.A. 26:2SS-1 to -20, “the Act”) in the near future. Continue reading

What you missed if you didn't attend the NJDPA Practice Enhancement Seminar

The conference room of the APA Hotel in Woodbridge was filled to capacity Monday, June 11, for the New Jersey Doctor-Patient Alliance Practice Enhancement Seminar focusing on what independent providers should do to prepare for the uncertainty coming with the new out-of-network law. From top left clockwise: Eric Poe, Leslie Howard, Joseph Ariyan, Neelendu Bose, Michael Maron, Sen. Joseph Lagana. Continue reading

Sarlo Seeks Explanation on Third Party Administrators

TRENTON–April 23, 2018–Senator Paul Sarlo wrote to State Treasurer Elizabeth Muoio seeking information on the use of third party administrators to manage the costs of health benefits for public workers. The TPA’s administer the State Health Benefits Plan and School Employees Health Benefit Plan by paying claims and negotiating charges with health care providers. Continue reading

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

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