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Helping Patients Navigate the Insurance Market Using Doctor-Patient Alliance

When it comes to health care providers, people who live in the United States have a variety of insurance plans to choose from. While it’s nice to have plentiful choices, it can quickly become overwhelming to decide which insurance plan is right for you and your family. From insurance premiums and out-of-pocket costs to deductibles and prescriptions, there are many factors to take into consideration. Dr. Peter DeNoble is an orthopedic surgeon based in New Jersey and he is making strides to become more transparent with his patients about their insurance options and care plans. In fact, Dr. DeNoble is President of The New Jersey Doctor-Patient Alliance (NJDPA) which aims to better unite patients and their doctors, creating greater transparency around insurance, billing, and affordable healthcare. “We all have insurance cards in our pockets – hopefully – but each card has a little three-letter word, like PPO or EPO or POS or HMO,” says Dr. DeNoble. “Through the NJDPA, we want to help people understand what those terms mean.” It’s true that, while many people have insurance, a lot of people are unsure what their plans actually cover. What access does your plan provide and how much responsibility falls back on you should you choose to see a certain doctor? The key is allowing patients the access needed to figure all of that out. Doctors should be a part of the conversation when it comes to choosing what plan is best for an individual, and their family if necessary. “That’s the information that the insurance companies don’t want to be transparent about,” says Dr. DeNoble. “And we [doctors] haven’t been good enough about educating our patients about it either. So, we’re going to do that with the NJDPA.” Dr. DeNoble understands that transparency is key when it comes to health care coverage. What’s the point of having coverage if you don’t know what it does and doesn’t cover? “Transparency is never a bad thing when it comes to the consumer,” says Dr. DeNoble. “It’s always lacking when it comes to the entities and the interest groups because, if you’re going to offer me a bad plan but it’s cheaper, I’m not going to tell you it’s a bad plan. I’m just going to tell you it’s the cheaper plan. You won’t know it’s a bad plan until you have a problem.” Helping people to understand that their coverage may come with limitations, if a doctor is needed, is essential. It can come as a surprise to many when emergencies happen- finding out you’re underinsured or have a “narrow network” can really put stress on your wallet. “A narrow network is a situation where there aren’t a whole lot of doctors who even accept the insurance card that you have,” says Dr. DeNoble. “And knowing that you have that or not is important.” Typically, employers offer employees a health insurance packet with some grids and some options. Perhaps you’ll discuss these options with your company’s HR person…but they don’t know your medical history. The best first-step in this situation is not to make a hasty choice. Take the time to visit The New Jersey Doctor-Patient Alliance website. Here, you’ll find all the resources patients may need, from a comprehensive insurance guide to education on surprise bills, price fixing, medicare rates, and more. “The website provides a nice overview of what to look for, beyond what’s in the grid and what’s written for you from your employer,” says Dr. DeNoble. “You want to be able to process the information from a couple of different sources. And, if there are questions that come up, you can reach out and ask them.”

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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.      

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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.

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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.

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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.

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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.

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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.

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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.

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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?

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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.

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